Provider Demographics
NPI:1386449957
Name:RUDELLI, GLEICE
Entity type:Individual
Prefix:
First Name:GLEICE
Middle Name:
Last Name:RUDELLI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7705 ARELLI DR
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-5133
Mailing Address - Country:US
Mailing Address - Phone:201-931-6287
Mailing Address - Fax:
Practice Address - Street 1:549 SKY HARBOR DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-3930
Practice Address - Country:US
Practice Address - Phone:727-724-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9588533163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse