Provider Demographics
NPI:1639946510
Name:TOOMER, GLORIA ONEAL
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:ONEAL
Last Name:TOOMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17449 MADISON GREEN DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3279
Mailing Address - Country:US
Mailing Address - Phone:813-205-5402
Mailing Address - Fax:
Practice Address - Street 1:27453 CASHFORD CIR UNIT 102B
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6918
Practice Address - Country:US
Practice Address - Phone:813-205-5402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL1204877335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier