Provider Demographics
NPI:1407232663
Name:O'NEILL, GLORIA
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9821 E BAY HARBOR DR APT 905
Mailing Address - Street 2:
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-1871
Mailing Address - Country:US
Mailing Address - Phone:305-450-9651
Mailing Address - Fax:305-418-7511
Practice Address - Street 1:9821 E BAY HARBOR DR APT 905
Practice Address - Street 2:
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-1871
Practice Address - Country:US
Practice Address - Phone:305-450-9651
Practice Address - Fax:786-535-1164
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9335407363LP0808X
AZAP8354363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP8354OtherANCC
FLRN9335407OtherRN