Provider Demographics
NPI:1649097163
Name:CARDENAS, GLORIA MARINA
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:MARINA
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:GLORIA
Other - Middle Name:
Other - Last Name:CARDENAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2384 SENTRY PALM DR APT 8-116
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-0053
Mailing Address - Country:US
Mailing Address - Phone:786-487-9941
Mailing Address - Fax:
Practice Address - Street 1:1341 E VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-3602
Practice Address - Country:US
Practice Address - Phone:407-768-1825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11033394363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner