MEDICARE: MS. SUZANNE R GLISSON N.P.

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	363L00000X	Nurse Practitioner	ARNP941732	FL

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	:	1275536351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUZANNE R GLISSON N.P.

Provider Business Mailing Address
First Line	:	508 S HABANA AVE STE 335
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4186
Country	:	US
Telephone Number	:	813-872-3679
Fax Number	:	813-350-4095

Provider Business Practice Location Address
First Line	:	508 S HABANA AVE STE 335
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4186
Country	:	US
Telephone Number	:	813-872-3679
Fax Number	:	813-350-4095

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	01/24/2019

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