Provider Demographics
NPI:1932681517
Name:GLADNEY, LIDIA VANESSA (PMHNP-BC, FNP-C, DNP)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:VANESSA
Last Name:GLADNEY
Suffix:
Gender:F
Credentials:PMHNP-BC, FNP-C, DNP
Other - Prefix:
Other - First Name:LIDIA
Other - Middle Name:VANESSA
Other - Last Name:ALVARADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6900 TAVISTOCK LAKES BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7593
Mailing Address - Country:US
Mailing Address - Phone:305-433-7147
Mailing Address - Fax:407-271-8526
Practice Address - Street 1:6900 TAVISTOCK LAKES BLVD STE 400
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7593
Practice Address - Country:US
Practice Address - Phone:305-842-4947
Practice Address - Fax:407-271-8526
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLANRP9372900363L00000X
FLANRP363LF0000X
FL9372900363LP2300X
FLAPRN9372900364SP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101170400Medicaid
FL19ZXGOtherFLORIDA BLUE ID
FL866H3OtherFLORIDA BLUE ID