Individual
MS. JEANETTE MARIE GLUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5070 MINTON RD NW STE 3, PALM BAY, FL 32907-1157
(321) 768-1600
(321) 255-2361
Mailing address
5070 MINTON RD NW STE 3, PALM BAY, FL 32907-1157
(321) 768-1600
(321) 435-0100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9103559
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y07HY
FLORIDA BLUE
FL
Enumeration date
04/14/2006
Last updated
10/01/2020
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