Provider Demographics
NPI:1508492158
Name:GLASS, ABIGAIL JESSICA (FNP-C)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:JESSICA
Last Name:GLASS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 TURNER ST
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:GA
Mailing Address - Zip Code:39846-6039
Mailing Address - Country:US
Mailing Address - Phone:229-254-7056
Mailing Address - Fax:
Practice Address - Street 1:265 TURNER ST
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:GA
Practice Address - Zip Code:39846-6039
Practice Address - Country:US
Practice Address - Phone:229-835-2251
Practice Address - Fax:229-835-2100
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN218980363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAMG5831234OtherDEA