Provider Demographics
NPI:1083268940
Name:GLASS, DANA JEAN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:JEAN
Last Name:GLASS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 MILITARY TRL STE 107
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4811
Mailing Address - Country:US
Mailing Address - Phone:561-427-2000
Mailing Address - Fax:561-776-2565
Practice Address - Street 1:4600 MILITARY TRL STE 107
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4811
Practice Address - Country:US
Practice Address - Phone:561-427-2000
Practice Address - Fax:561-776-2565
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003478363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner