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General NPI Number Information
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NPI Number | 1275841447
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Entity Type | Individual
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Provider Name | MR. GLENN A BURKETT
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Gender | Male
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Dates
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Enumeration Date | 09/21/2010
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Last Update Date | 09/21/2010
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Provider Practice Location Address
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Address Line | 5431 AIRPORT PULLING RD N
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City | NAPLES
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State | FL
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Zip | 34109-2004
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Country | US
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Telephone | 239-596-3611
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Fax | 239-596-6011
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Provider Business Mailing Address
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Address Line | PO BOX 9507
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32417-9507
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Country | US
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Telephone | 850-872-8752
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Fax | 850-249-3290
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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