Provider Demographics
NPI:1821770546
Name:GLICK, JOANNA JOY (FNP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:JOY
Last Name:GLICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 VIOLA DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-2073
Mailing Address - Country:US
Mailing Address - Phone:956-607-1352
Mailing Address - Fax:
Practice Address - Street 1:1900 S JACKSON RD STE 1
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1589
Practice Address - Country:US
Practice Address - Phone:956-340-4222
Practice Address - Fax:956-307-3234
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1130352363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care