Provider Demographics
NPI:1275094088
Name:GLENN, ALEXANDRA CORY BRIENZA (AGACNP)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:CORY BRIENZA
Last Name:GLENN
Suffix:
Gender:F
Credentials:AGACNP
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 131329
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-6329
Mailing Address - Country:US
Mailing Address - Phone:205-271-8541
Mailing Address - Fax:
Practice Address - Street 1:513 BROOKWOOD BLVD STE 275
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6806
Practice Address - Country:US
Practice Address - Phone:205-502-4700
Practice Address - Fax:205-502-5183
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-161741163WR0006X, 363LA2100X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No163W00000XNursing Service ProvidersRegistered Nurse