Healthcare Provider Details

I. General information

NPI: 1316643695
Provider Name (Legal Business Name): ZION GLADE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 MCDONOGH RD STE 201
OWINGS MILLS MD
21117
US

IV. Provider business mailing address

201 DEFENSE HWY STE 205
ANNAPOLIS MD
21401-7096
US

V. Phone/Fax

Practice location:
  • Phone: 855-527-7246
  • Fax: 866-229-5063
Mailing address:
  • Phone: 855-527-7246
  • Fax: 866-229-5063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR244112
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11021931
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: