Provider Demographics
NPI:1407396195
Name:THOMAS, GLENDA (DNP-FNP)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2826 OLD LEE HWY STE 250
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4348
Mailing Address - Country:US
Mailing Address - Phone:703-854-1298
Mailing Address - Fax:703-854-1305
Practice Address - Street 1:2826 OLD LEE HWY STE 250
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031
Practice Address - Country:US
Practice Address - Phone:703-854-1298
Practice Address - Fax:703-854-1305
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174347363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily