Provider Demographics
NPI:1073656203
Name:TURNER, GLENN DAVID (ARNP)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:DAVID
Last Name:TURNER
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10121 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THONOTOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:33592-2908
Mailing Address - Country:US
Mailing Address - Phone:813-986-3126
Mailing Address - Fax:
Practice Address - Street 1:3302 W BAKER ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-2851
Practice Address - Country:US
Practice Address - Phone:813-752-1336
Practice Address - Fax:813-754-6914
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3209212363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307139100Medicaid
FLP00823821OtherRAILROAD MCR LINKED TO GRP# CE0943
FLY109POtherBCBS OF FL
FLAL270ZMedicare PIN