Provider Demographics
NPI:1013532738
Name:GLOVER, CEYDA
Entity Type:Individual
Prefix:
First Name:CEYDA
Middle Name:
Last Name:GLOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JADA
Other - Middle Name:
Other - Last Name:GLOVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CLC
Mailing Address - Street 1:1656 LOVES POINT DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6726
Mailing Address - Country:US
Mailing Address - Phone:321-422-2407
Mailing Address - Fax:
Practice Address - Street 1:1656 LOVES POINT DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6726
Practice Address - Country:US
Practice Address - Phone:321-422-2407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
318796174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
318796OtherCERTIFIED LACTATION COUNSELOR