Provider Demographics
NPI:1407522097
Name:SUMMERS, GLADYS AMELIA (PBT)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:AMELIA
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:PBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 SE 19TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33035-1300
Mailing Address - Country:US
Mailing Address - Phone:813-409-5796
Mailing Address - Fax:
Practice Address - Street 1:2614 SE 19TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33035-1300
Practice Address - Country:US
Practice Address - Phone:813-409-5796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1407521097246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1407522097OtherOTHER