MEDICARE: GLUCOSEWELL LLC

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	363LA2100X	Acute Care Nurse Practitioner
2	363LA2200X	Adult Health Nurse Practitioner

General Provider Information

NPI Number	:	1952092363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLUCOSEWELL LLC

Provider Business Mailing Address
First Line	:	220 5TH AVE FL 11
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-8017
Country	:	US
Telephone Number	:	786-863-4875
Fax Number	:

Provider Business Practice Location Address
First Line	:	3081 SALZEDO ST STE 202L
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6722
Country	:	US
Telephone Number	:	786-863-4875
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	THU NGUYEN
Credential	:
Telephone Number	:	786-863-4875

Provider Enumeration Date	:	05/17/2023
Last Update Date	:	11/27/2023

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Directions to “GLUCOSEWELL LLC ” Practice Location

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