Provider Demographics
NPI:1225612245
Name:GLACY, TIANA (RN)
Entity Type:Individual
Prefix:
First Name:TIANA
Middle Name:
Last Name:GLACY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4573 STATE ROUTE 40
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:NY
Mailing Address - Zip Code:12809-3474
Mailing Address - Country:US
Mailing Address - Phone:518-638-8274
Mailing Address - Fax:
Practice Address - Street 1:4573 STATE ROUTE 40
Practice Address - Street 2:
Practice Address - City:ARGYLE
Practice Address - State:NY
Practice Address - Zip Code:12809-3474
Practice Address - Country:US
Practice Address - Phone:518-638-8274
Practice Address - Fax:518-638-6420
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY715251163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse