Provider Demographics
NPI:1780122416
Name:GLOVER, SAMUEL
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:GLOVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 ROYAL HUNT DR
Mailing Address - Street 2:APT. #303
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-2532
Mailing Address - Country:US
Mailing Address - Phone:813-369-4202
Mailing Address - Fax:
Practice Address - Street 1:6310 ROYAL HUNT DR
Practice Address - Street 2:APT. #303
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-2532
Practice Address - Country:US
Practice Address - Phone:813-369-4202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician