MEDICARE: MRS. BETTY SOPHIA GLAUBERZON AGPCNP

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	363L00000X	Nurse Practitioner	239625	AZ
2	363LF0000X	Family Nurse Practitioner	239625	AZ

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	:	1801411855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETTY SOPHIA GLAUBERZON AGPCNP

Provider Business Mailing Address
First Line	:	5055 E BROADWAY BLVD STE A100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3629
Country	:	US
Telephone Number	:	520-382-1205
Fax Number	:

Provider Business Practice Location Address
First Line	:	5880 N LA CHOLLA BLVD STE 150
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-3592
Country	:	US
Telephone Number	:	520-751-3602
Fax Number	:	520-547-5761

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

Provider Enumeration Date	:	06/15/2020
Last Update Date	:	03/01/2021

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