Provider Demographics
NPI:1457161341
Name:GLASCO, TASHA
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:GLASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SOUTHTOWN CIR
Mailing Address - Street 2:
Mailing Address - City:ROLESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27571-9573
Mailing Address - Country:US
Mailing Address - Phone:984-255-4590
Mailing Address - Fax:
Practice Address - Street 1:300 SOUTHTOWN CIR
Practice Address - Street 2:
Practice Address - City:ROLESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27571-9573
Practice Address - Country:US
Practice Address - Phone:984-255-4590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist