Provider Demographics
NPI:1861844417
Name:GLOVER, DEONA BERNA
Entity Type:Individual
Prefix:MS
First Name:DEONA
Middle Name:BERNA
Last Name:GLOVER
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:PO BOX 882
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-0882
Mailing Address - Country:US
Mailing Address - Phone:352-874-0432
Mailing Address - Fax:
Practice Address - Street 1:2533 SENNETT DR
Practice Address - Street 2:201
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7291
Practice Address - Country:US
Practice Address - Phone:352-874-0432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-0056R14246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy