MEDICARE: GLENDA GARCIA APRN, FNP, PMHNP-BC

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	F11200332	FL
2	163W00000X	Registered Nurse	RN9427323	FL
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2022096470	FL
4	363L00000X	Nurse Practitioner	APRN11010381	FL

General Provider Information

NPI Number	:	1790387975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENDA GARCIA APRN, FNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	7321 SW 142ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-3162
Country	:	US
Telephone Number	:	786-973-6242
Fax Number	:

Provider Business Practice Location Address
First Line	:	12150 SW 128TH CT STE 123
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-4672
Country	:	US
Telephone Number	:	786-973-6242
Fax Number	:

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

Provider Enumeration Date	:	11/12/2020
Last Update Date	:	07/06/2023

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