Provider Demographics
NPI:1902819931
Name:GLORIA, DEBBIE (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:GLORIA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:R
Other - Last Name:GLORIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:4727 SUNBEAM RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-6187
Mailing Address - Country:US
Mailing Address - Phone:904-880-0622
Mailing Address - Fax:904-880-0623
Practice Address - Street 1:1545 S 14TH ST
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3049
Practice Address - Country:US
Practice Address - Phone:904-261-7500
Practice Address - Fax:904-261-2166
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9204692363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4856ZMedicare ID - Type Unspecified
FLQ44924Medicare UPIN