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General NPI Number Information
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NPI Number | 1740077890
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Entity Type | Individual
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Provider Name | MRS. GLADYS M OTTENWALDER
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Gender | Female
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Dates
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Enumeration Date | 04/22/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 7082 OVENBIRD RD
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City | WEEKI WACHEE
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State | FL
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Zip | 34613-6336
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Country | US
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Telephone | 813-471-8833
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Fax |
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Provider Business Mailing Address
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Address Line | 7082 OVENBIRD RD
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City | WEEKI WACHEE
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State | FL
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Zip | 34613-6336
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Country | US
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Telephone | 813-471-8833
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F03250639
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License Number State | FL
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