Provider Demographics
NPI:1346645116
Name:KENNEDY, GLORIA JEAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:JEAN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:GLORIA
Other - Middle Name:JEAN
Other - Last Name:DEMARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:26032 NEWCOMBE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748
Mailing Address - Country:US
Mailing Address - Phone:585-355-9169
Mailing Address - Fax:
Practice Address - Street 1:26032 NEWCOMBE CIRCLE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748
Practice Address - Country:US
Practice Address - Phone:585-355-9169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5198127164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse