Provider Demographics
NPI:1952513012
Name:WINCHESTER, GLENDA DEAN (ANP)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:DEAN
Last Name:WINCHESTER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7431 114TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-5119
Mailing Address - Country:US
Mailing Address - Phone:800-632-6074
Mailing Address - Fax:
Practice Address - Street 1:911 S HUGHES ST
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-7731
Practice Address - Country:US
Practice Address - Phone:919-363-6011
Practice Address - Fax:919-363-6013
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5003647363L00000X
OKR0073024364SR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SR0400XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00680790OtherPALMETTO GBA PROVIDER#
OK200080840AMedicaid
NC2593375Medicare PIN
OK731476339Medicare UPIN
OK200080840AMedicaid