Provider Demographics
NPI:1871051771
Name:HOUGHTON, GLENDA ROSE (MSN APRN A-GNP-C)
Entity type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:ROSE
Last Name:HOUGHTON
Suffix:
Gender:F
Credentials:MSN APRN A-GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 SUNNINGDALE DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-3185
Mailing Address - Country:US
Mailing Address - Phone:678-925-4276
Mailing Address - Fax:
Practice Address - Street 1:2605 SUNNINGDALE DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-3185
Practice Address - Country:US
Practice Address - Phone:678-925-4276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-09
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001726363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner