Healthcare Provider Details

I. General information

NPI: 1417974841
Provider Name (Legal Business Name): GLORIA ANN GLIDEWELL CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TAMPA GENERAL CIR FL STC4 DEPT OF OB/GYN
TAMPA FL
33606-3603
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-0001
US

V. Phone/Fax

Practice location:
  • Phone: 813-259-8500
  • Fax:
Mailing address:
  • Phone: 813-974-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number588747
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP9447146
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: