Provider Demographics
NPI:1851762801
Name:GLASCOCK, DARCY RACOFF (NP)
Entity Type:Individual
Prefix:
First Name:DARCY
Middle Name:RACOFF
Last Name:GLASCOCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 HICKORY FLAT HWY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-7252
Mailing Address - Country:US
Mailing Address - Phone:770-720-0610
Mailing Address - Fax:
Practice Address - Street 1:6120 HICKORY FLAT HWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-7252
Practice Address - Country:US
Practice Address - Phone:770-720-0610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN203792363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily