Individual
MRS. GLORIA MOBLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ADMINISTRATOR
Contact information
Practice address
3704 NE ROCKY FORD RD, MADISON, FL 32340-4020
(850) 253-0106
Mailing address
3704 NE ROCKY FORD RD, MADISON, FL 32340-4020
(850) 253-0106
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
6906618
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46-2850483
FEIN
FL
Enumeration date
09/10/2013
Last updated
09/10/2013
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