Provider Demographics
NPI:1467675546
Name:GLAZER, CAROL THERESE (ARNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:THERESE
Last Name:GLAZER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 CLAYS TRL
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-4839
Mailing Address - Country:US
Mailing Address - Phone:727-786-8694
Mailing Address - Fax:
Practice Address - Street 1:1173 CLAYS TRL
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-4839
Practice Address - Country:US
Practice Address - Phone:727-786-8694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1072972363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE33632Medicare ID - Type Unspecified