Provider Demographics
NPI:1407903008
Name:GLORIOSO, JENNIFER (RN-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GLORIOSO
Suffix:
Gender:F
Credentials:RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5280 W FIREOPAL WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-9429
Mailing Address - Country:US
Mailing Address - Phone:520-744-7625
Mailing Address - Fax:
Practice Address - Street 1:5280 W FIREOPAL WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742-9429
Practice Address - Country:US
Practice Address - Phone:520-744-7625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN129968163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice