Provider Demographics
NPI:1790387975
Name:GARCIA, GLENDA (APRN, FNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:APRN, FNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7321 SW 142ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3162
Mailing Address - Country:US
Mailing Address - Phone:786-973-6242
Mailing Address - Fax:
Practice Address - Street 1:12150 SW 128TH CT STE 123
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4672
Practice Address - Country:US
Practice Address - Phone:786-973-6242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF11200332363LF0000X
FLRN9427323163W00000X
FL2022096470363LP0808X
FLAPRN11010381363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health