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NPI Code Detail

MEDICARE: RONNIE G GLADDEN FNP

MEDICARE: RONNIE G GLADDEN FNP
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
1363L00000XNurse PractitionerARNP 9346857FL
2363LF0000XFamily Nurse PractitionerRN110241 NPGA

General Provider Information

NPI Number : 1629181110
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONNIE G GLADDEN FNP
Provider Business Mailing Address
First Line : PO BOX 1239
Second Line :
City : TROY
State : MI
Zip : 48099-1239
Country : US
Telephone Number : 248-824-6600
Fax Number : 855-618-6655
Provider Business Practice Location Address
First Line : 4348 SOUTHPOINT BLVD
Second Line : SUITE 100
City : JACKSONVILLE
State : FL
Zip : 32216-0903
Country : US
Telephone Number : 904-281-1915
Fax Number : 904-281-1119
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2006
Last Update Date : 07/10/2014

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