Provider Demographics
NPI:1629409552
Name:GLASS, PAULA ELLEN (APRN)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:ELLEN
Last Name:GLASS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7935 NEW HOLLAND WAY
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-6345
Mailing Address - Country:US
Mailing Address - Phone:954-254-1871
Mailing Address - Fax:
Practice Address - Street 1:15300 S JOG RD STE 101
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2164
Practice Address - Country:US
Practice Address - Phone:561-734-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
FL1485952363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No174H00000XOther Service ProvidersHealth Educator