Individual
GLORYIAN D. EWING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT, LPN
Contact information
Practice address
6501 ARLINGTON EXPY BLDG A, JACKSONVILLE, FL 32211-5779
(904) 649-6084
Mailing address
8407 HERLONG RD, JACKSONVILLE, FL 32210-2327
(904) 666-8952
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
PN 5178499
FL
225700000X
Massage Therapist
Primary
MA102448
FL
225700000X
Massage Therapist
MA44439
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A25766
—
FL
Enumeration date
05/14/2010
Last updated
05/23/2023
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