Provider Demographics
NPI:1720605462
Name:GLICKMAN, ANNA MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:GLICKMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:RONNERUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1653 E MCMURRAY BLVD STE 132
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-5934
Mailing Address - Country:US
Mailing Address - Phone:520-876-0478
Mailing Address - Fax:
Practice Address - Street 1:1653 E MCMURRAY BLVD STE 132
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5934
Practice Address - Country:US
Practice Address - Phone:520-876-0478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ242373363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily