Individual
GLENN MACLEAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
2100 VIA BELLA BLVD, SUITE 101, LAND O LAKES, FL 34639-5403
(813) 948-1498
(813) 909-8113
Mailing address
38135 MARKET SQUARE, ZEPHYRHILLS, FL 33542
(813) 780-1255
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA37329
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00909173
RR MEDICARE
FL
Enumeration date
08/05/2006
Last updated
05/24/2011
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