Provider Demographics
NPI:1003218793
Name:GLOVER-BROCKINTON, TAMMIE R (APRN)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:R
Last Name:GLOVER-BROCKINTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TAMMIE
Other - Middle Name:R
Other - Last Name:GLOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 MCEUEN DR
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-9329
Mailing Address - Country:US
Mailing Address - Phone:501-920-9426
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004174363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily