Provider Demographics
NPI:1235636192
Name:GARCIA, MA GLENDA ABAC (ARNP)
Entity Type:Individual
Prefix:
First Name:MA GLENDA
Middle Name:ABAC
Last Name:GARCIA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MA GLENDA
Other - Middle Name:GETEZ
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:3340 WARNELL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1160
Mailing Address - Country:US
Mailing Address - Phone:904-928-3686
Mailing Address - Fax:
Practice Address - Street 1:3340 WARNELL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1160
Practice Address - Country:US
Practice Address - Phone:904-928-3686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-08
Last Update Date:2018-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2569962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP2569962Medicaid