Provider Demographics
NPI:1710125349
Name:GLORIOSA ANTIPORDA, M.D.,P.A.
Entity Type:Organization
Organization Name:GLORIOSA ANTIPORDA, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLORIOSA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANTIPORDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-713-8074
Mailing Address - Street 1:PO BOX 850001
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0001
Mailing Address - Country:US
Mailing Address - Phone:904-282-6331
Mailing Address - Fax:904-282-1550
Practice Address - Street 1:2040 RIVERVIEW ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-2657
Practice Address - Country:US
Practice Address - Phone:904-713-8074
Practice Address - Fax:904-924-8217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49981207Q00000X
FLME47869207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8349Medicare PIN