Provider Demographics
NPI:1467875005
Name:NOBLES, GLEN CHARLES JR (NP-C)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:CHARLES
Last Name:NOBLES
Suffix:JR
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-1846
Mailing Address - Country:US
Mailing Address - Phone:850-638-6240
Mailing Address - Fax:850-415-5010
Practice Address - Street 1:1338 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-1846
Practice Address - Country:US
Practice Address - Phone:850-638-6240
Practice Address - Fax:850-415-5010
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9320777363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily