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General NPI Number Information
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NPI Number | 1811215858
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Entity Type | Individual
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Provider Name | GLORYIAN D. EWING LMT, LPN
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Gender | Female
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Dates
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Enumeration Date | 05/14/2010
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 6501 ARLINGTON EXPY BLDG A
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City | JACKSONVILLE
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State | FL
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Zip | 32211-5779
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Country | US
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Telephone | 904-649-6084
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Fax |
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Provider Business Mailing Address
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Address Line | 8407 HERLONG RD
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City | JACKSONVILLE
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State | FL
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Zip | 32210-2327
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Country | US
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Telephone | 904-666-8952
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN 5178499
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA44439
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA102448
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License Number State | FL
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