MEDICARE: MS. ERICA CHAMBRIELLE GLOVER

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	374J00000X	Doula

General Provider Information

NPI Number	:	1841521085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERICA CHAMBRIELLE GLOVER

Provider Business Mailing Address
First Line	:	451 MONUMENT RD
Second Line	:	#704
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-6435
Country	:	US
Telephone Number	:	904-233-4544
Fax Number	:	904-764-9592

Provider Business Practice Location Address
First Line	:	451 MONUMENT RD
Second Line	:	#704
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-6435
Country	:	US
Telephone Number	:	904-233-4544
Fax Number	:	904-764-9592

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

Provider Enumeration Date	:	01/28/2010
Last Update Date	:	01/28/2010

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