Provider Demographics
NPI:1104396209
Name:COLLINS, GLENDA TRUESDELL (NP-C)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:TRUESDELL
Last Name:COLLINS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 MEDICAL PARK DR STE 300
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-4987
Mailing Address - Country:US
Mailing Address - Phone:800-809-1265
Mailing Address - Fax:
Practice Address - Street 1:690 MEDICAL PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-4987
Practice Address - Country:US
Practice Address - Phone:800-809-1265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22337363LF0000X
GANP000462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily