Organization
GLORIA JEAN LELAIDIER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLORIA LELAIDIER ARNP, CNM (PRESIDENT)
(904) 829-2686
Entity
Organization
Contact information
Practice address
72 SOUTH ST, ST AUGUSTINE, FL 32084-5127
(904) 824-4990
(904) 824-2226
Mailing address
PO BOX 3123, ST AUGUSTINE, FL 32085-3123
(904) 824-4990
(904) 824-2226
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
ARNP1634442
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000392200
—
FL
Enumeration date
02/12/2010
Last updated
02/12/2010
Update your record
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