Basic Information
| Provider Information | |||||||||
| NPI: | 1417974841 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLIDEWELL | ||||||||
| FirstName: | GLORIA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 917770 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328910001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139742201 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 TAMPA GENERAL CIR FL STC4 | ||||||||
| Address2: | DEPT OF OB/GYN | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336063603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132598500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 10/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 588747 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | ARNP9447146 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | C3CGU | 01 | FL | BLUE CROSS BLUE SHEILD | OTHER | 165160601 | 05 | TX | MEDICAID | IY22Z | 01 | FL | MEDICARE | OTHER | 037066002 | 05 | TX | MEDICAID | 8N4950 | 01 | BCBS | OTHER | 8Y1054 | 01 | TX | BCBS | OTHER | 020696500 | 05 | FL | MEDICAID |