Individual
GLENDA KOLLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSN
Contact information
Practice address
105 DEVON ST, PORT ORANGE, FL 32127-5924
(704) 964-8226
Mailing address
105 DEVON ST, PORT ORANGE, FL 32127-5924
(704) 964-8226
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
176866
NC
163W00000X
Registered Nurse
Primary
RN3388052
FL
Other
Enumeration date
09/04/2015
Last updated
09/04/2015
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