MEDICARE: DR. GLENDA MARIE NIEVES PEREZ M.D.

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	208D00000X	General Practice Physician	ACN799	FL
2	208D00000X	General Practice Physician	16,898	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1538355060	OTHER	FL	NPI
2	ACN799	OTHER	FL	STATE LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538355060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENDA MARIE NIEVES PEREZ M.D.

Provider Business Mailing Address
First Line	:	425 W COLONIAL DR STE 303
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-6863
Country	:	US
Telephone Number	:	321-758-2966
Fax Number	:	407-286-4515

Provider Business Practice Location Address
First Line	:	1931 S NARCOOSSEE RD
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34771-7211
Country	:	US
Telephone Number	:	407-986-9642
Fax Number	:	407-593-6102

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

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	08/14/2025

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