MEDICARE: GLOMAR MEDICAL INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053913095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLOMAR MEDICAL INC.

Provider Business Mailing Address
First Line	:	341 ALLISON DR
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32908-6405
Country	:	US
Telephone Number	:	321-543-9830
Fax Number	:

Provider Business Practice Location Address
First Line	:	341 ALLISON DR
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32908-6405
Country	:	US
Telephone Number	:	321-543-9830
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	NEIL J FREY
Credential	:	APRN
Telephone Number	:	321-543-9830

Provider Enumeration Date	:	11/13/2020
Last Update Date	:	12/03/2020

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Directions to “GLOMAR MEDICAL INC. ” Practice Location

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