Provider Demographics
NPI:1417051889
Name:GARLINGTON, GLEN THOMAS (NP)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:THOMAS
Last Name:GARLINGTON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 HARRIS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4265
Mailing Address - Country:US
Mailing Address - Phone:817-433-3450
Mailing Address - Fax:817-294-6429
Practice Address - Street 1:6301 HARRIS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4265
Practice Address - Country:US
Practice Address - Phone:817-433-3450
Practice Address - Fax:817-294-6429
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283285903Medicaid
TX283285901Medicaid
TX283285903Medicaid
TXTXB133801Medicare PIN
TX283285901Medicaid