Provider Demographics
NPI:1821280314
Name:THOMAS, GLENDA J (APRN)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:J
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 BLUE HILLS AVE
Mailing Address - Street 2:PHYSICIAN'S OFFICE SUITE
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1513
Mailing Address - Country:US
Mailing Address - Phone:860-714-4694
Mailing Address - Fax:860-714-8096
Practice Address - Street 1:490 BLUE HILLS AVE
Practice Address - Street 2:PHYSICIAN'S OFFICE SUITE
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1513
Practice Address - Country:US
Practice Address - Phone:860-714-4694
Practice Address - Fax:860-714-8096
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001200363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner