Provider Demographics
NPI:1104200476
Name:GLIDDEN, GERIE LYNN (APRN FNP BC)
Entity Type:Individual
Prefix:
First Name:GERIE
Middle Name:LYNN
Last Name:GLIDDEN
Suffix:
Gender:F
Credentials:APRN FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-3229
Mailing Address - Fax:956-362-4088
Practice Address - Street 1:5502 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8747
Practice Address - Country:US
Practice Address - Phone:956-362-3229
Practice Address - Fax:956-362-4088
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128482363LX0001X, 363LF0000X, 363LX0001X
TNAP128482363LF0000X
MECNP181060363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350672701Medicaid
TX442090YNG9Medicare PIN