MEDICARE: EMILY ANN GLOSSOP 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
1	363LF0000X	Family Nurse Practitioner	APRN11005951	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	:	1588295422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ANN GLOSSOP APRN

Provider Business Mailing Address
First Line	:	1241 AIRPORT RD STE M
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-2954
Country	:	US
Telephone Number	:	850-460-7090
Fax Number	:

Provider Business Practice Location Address
First Line	:	1241 AIRPORT RD STE M
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-2954
Country	:	US
Telephone Number	:	850-460-7090
Fax Number	:

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

Provider Enumeration Date	:	01/29/2020
Last Update Date	:	11/21/2021

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Directions to “ EMILY ANN GLOSSOP APRN” Practice Location

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