Healthcare Provider Details

I. General information

NPI: 1861072605
Provider Name (Legal Business Name): GLAIMET ALEXANDRA GOMEZ NIMLIN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3070 E COLLEGE AVE
RUSKIN FL
33570-5220
US

IV. Provider business mailing address

5719 1ST AVENUE DR W
BRADENTON FL
34209-2509
US

V. Phone/Fax

Practice location:
  • Phone: 813-641-2945
  • Fax:
Mailing address:
  • Phone: 941-203-9174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number28092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: