Healthcare Provider Details

I. General information

NPI: 1689690307
Provider Name (Legal Business Name): GLENN CURTISS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 BRUCE B DOWNS BLVD J. A. HALEY VAMC (116B)
TAMPA FL
33612-4745
US

IV. Provider business mailing address

23933 FOREST VIEW DR
LAND O LAKES FL
34639-4849
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-2000
  • Fax:
Mailing address:
  • Phone: 813-996-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY4068
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPY4068
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: