Provider Demographics
NPI:1477602472
Name:GLOVER, TERRI DENNEL (MAOM)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:DENNEL
Last Name:GLOVER
Suffix:
Gender:F
Credentials:MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W 33RD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-6428
Mailing Address - Country:US
Mailing Address - Phone:904-634-1549
Mailing Address - Fax:
Practice Address - Street 1:1100 CESERY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5656
Practice Address - Country:US
Practice Address - Phone:904-745-3070
Practice Address - Fax:904-745-3087
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator