Provider Demographics
NPI:1790249092
Name:WORTHAM, GLINDA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:GLINDA
Middle Name:
Last Name:WORTHAM
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 1:83381 PURPLE MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-2631
Mailing Address - Country:US
Mailing Address - Phone:904-631-4685
Mailing Address - Fax:
Practice Address - Street 1:851042 US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-2845
Practice Address - Country:US
Practice Address - Phone:904-633-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001244363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily