Provider Demographics
NPI:1417974841
Name:GLIDEWELL, GLORIA ANN (CNM)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:ANN
Last Name:GLIDEWELL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:813-974-2201
Mailing Address - Fax:
Practice Address - Street 1:2 TAMPA GENERAL CIR FL STC4
Practice Address - Street 2:DEPT OF OB/GYN
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3603
Practice Address - Country:US
Practice Address - Phone:813-259-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX588747367A00000X
FLARNP9447146367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC3CGUOtherBLUE CROSS BLUE SHEILD
TX165160601Medicaid
FLIY22ZOtherMEDICARE
TX037066002Medicaid
8N4950OtherBCBS
TX8Y1054OtherBCBS
FL020696500Medicaid