Healthcare Provider Details

I. General information

NPI: 1427922335
Provider Name (Legal Business Name): PATRICIA A GLASS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 LOUISIANA AVE
SAINT CLOUD FL
34769-4116
US

IV. Provider business mailing address

5020 JEAN ST
COCOA FL
32927-9218
US

V. Phone/Fax

Practice location:
  • Phone: 407-593-0122
  • Fax:
Mailing address:
  • Phone: 831-801-8759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11042551
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: