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General NPI Number Information
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NPI Number | 1487824728
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Entity Type | Individual
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Provider Name | GLORIA KOO REID NP
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Gender | Female
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 4205 BELFORT RD STE 2069
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1471
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Country | US
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Telephone | 904-450-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 4205 BELFORT RD STE 2069
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1471
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Country | US
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Telephone | 904-450-8500
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | R168950
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License Number State | MD
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