Provider Demographics
NPI:1588108112
Name:GLYMPH, JESSICA TAYLOR (FNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:TAYLOR
Last Name:GLYMPH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:896-797-6306
Mailing Address - Fax:
Practice Address - Street 1:12016 N RADIO STATION RD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-1143
Practice Address - Country:US
Practice Address - Phone:864-882-6141
Practice Address - Fax:864-882-6680
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20651363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily