Provider Demographics
NPI:1063480416
Name:GLIDEWELL NEAL, AMANDA (NP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GLIDEWELL NEAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 BILLINGSLY CT STE 6
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6445
Mailing Address - Country:US
Mailing Address - Phone:615-778-0509
Mailing Address - Fax:615-778-0209
Practice Address - Street 1:2545 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38012-1610
Practice Address - Country:US
Practice Address - Phone:615-778-0509
Practice Address - Fax:615-778-0209
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN7068363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3907731Medicaid
TN3907731Medicare ID - Type UnspecifiedMEDICARE
P37589Medicare UPIN