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NPI Code Detail

MEDICARE: HEATHER LYNN GLASS APRN

MEDICARE: HEATHER LYNN GLASS APRN
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
1363LF0000XFamily Nurse Practitioner11007189FL

General Provider Information

NPI Number : 1407479702
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER LYNN GLASS APRN
Provider Business Mailing Address
First Line : 3030 CUMMINGS AVE
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32311-3738
Country : US
Telephone Number : 352-817-2247
Fax Number :
Provider Business Practice Location Address
First Line : 7755 CENTER AVE STE 630
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92647-9152
Country : US
Telephone Number : 657-237-2450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2020
Last Update Date : 10/04/2022

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