Provider Demographics
NPI:1710504725
Name:HATEM, GLADYS ELENA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:ELENA
Last Name:HATEM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44047
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4047
Mailing Address - Country:US
Mailing Address - Phone:904-376-3240
Mailing Address - Fax:904-391-5075
Practice Address - Street 1:836 PRUDENTIAL DR STE 802
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8335
Practice Address - Country:US
Practice Address - Phone:904-202-8290
Practice Address - Fax:904-202-8171
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007713363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner