MEDICARE: DR. GLORIA S TIPTON ED.D., M.S.W.

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	1041C0700X	Clinical Social Worker	SW3782	FL

General Provider Information

NPI Number	:	1760675649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLORIA S TIPTON ED.D., M.S.W.

Provider Business Mailing Address
First Line	:	215 FOREST PARK CIR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4916
Country	:	US
Telephone Number	:	850-249-1524
Fax Number	:	850-215-5657

Provider Business Practice Location Address
First Line	:	215 FOREST PARK CIR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4916
Country	:	US
Telephone Number	:	850-249-1524
Fax Number	:	850-215-5658

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

Provider Enumeration Date	:	08/23/2007
Last Update Date	:	08/23/2007

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