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General NPI Number Information
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NPI Number | 1467783886
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Entity Type | Individual
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Provider Name | THERESA MARIE GLOSTER CRNA
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Gender | Female
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Dates
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Enumeration Date | 01/25/2010
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Last Update Date | 06/03/2013
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Provider Practice Location Address
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Address Line | 3130 ATWATER DR
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City | NORTH PORT
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State | FL
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Zip | 34288-8302
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Country | US
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Telephone | 814-421-8945
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Fax |
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Provider Business Mailing Address
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Address Line | 3130 ATWATER DR
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City | NORTH PORT
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State | FL
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Zip | 34288-8302
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Country | US
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Telephone | 814-421-8945
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Fax |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN573951
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License Number State | PA
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