MEDICARE: DR. PORTIA ANTOINETTE GLOVER ARNP

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	363LF0000X	Family Nurse Practitioner	9320168	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	:	1396134904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PORTIA ANTOINETTE GLOVER ARNP

Provider Business Mailing Address
First Line	:	5851 TIMUQUANA RD STE 104
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-7890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5851 TIMUQUANA RD STE 104
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-7890
Country	:	US
Telephone Number	:	904-416-0601
Fax Number	:

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

Provider Enumeration Date	:	01/20/2015
Last Update Date	:	06/01/2023

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