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General NPI Number Information
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NPI Number | 1851189260
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Entity Type | Organization
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Legal Business Name | GLOWTOX STUDIO LLC
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Dates
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Enumeration Date | 04/26/2025
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 3228 SW MARTIN DOWNS BLVD STE 200
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City | PALM CITY
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State | FL
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Zip | 34990-2680
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Country | US
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Telephone | 772-223-0620
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Fax | 772-223-0640
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Provider Business Mailing Address
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Address Line | 1914 SW NOTRE DAME AVE
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-2469
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Country | US
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Telephone | 305-979-7195
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Fax | 262-425-8964
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | LUIS ENRIQUE MORERA
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Credential | APRN
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Telephone | 305-979-7195
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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