Provider Demographics
NPI:1992531057
Name:GLASSCOCK, GRACE ANN (CRNP)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ANN
Last Name:GLASSCOCK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15229 LAKE PAYNE RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35456-1241
Mailing Address - Country:US
Mailing Address - Phone:205-393-7241
Mailing Address - Fax:
Practice Address - Street 1:1050 RUBY TYLER PKWY
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-2958
Practice Address - Country:US
Practice Address - Phone:205-759-7953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-183331363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily