Provider Demographics
NPI:1568630127
Name:GLINES, ERIC L (ARNP)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:L
Last Name:GLINES
Suffix:
Gender:M
Credentials:ARNP
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 1230
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1230
Mailing Address - Country:US
Mailing Address - Phone:812-492-5457
Mailing Address - Fax:812-464-4485
Practice Address - Street 1:4015 GATEWAY BLVD STE 2120
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-9460
Practice Address - Country:US
Practice Address - Phone:812-464-0521
Practice Address - Fax:812-464-0565
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28144999A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000559731OtherANTHEM
IN200911350Medicaid
IN532500OOOMedicare PIN