Individual
MR. GLEN CURTIS WOMBLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNFA
Contact information
Practice address
4740 SMITHFIELD, MELBOURNE, FL 32934-7864
(321) 288-5605
(321) 242-8415
Mailing address
4740 SMITHFIELD, MELBOURNE, FL 32934-7864
(321) 242-8415
(321) 242-8415
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
RN3180082
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y100B
BCBS PROVIDER NUMBER
FL
Enumeration date
01/23/2007
Last updated
07/08/2007
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