Healthcare Provider Details

I. General information

NPI: 1407232663
Provider Name (Legal Business Name): DR. GLORIA O'NEILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 GOLD AVE SW STE 1060
ALBUQUERQUE NM
87102-3263
US

IV. Provider business mailing address

9821 E BAY HARBOR DR APT 905
BAY HARBOR ISLANDS FL
33154-1871
US

V. Phone/Fax

Practice location:
  • Phone: 305-450-9651
  • Fax:
Mailing address:
  • Phone: 305-450-9651
  • Fax: 305-418-7511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP8354
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9335407
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number54907
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: