Provider Demographics
NPI:1922525435
Name:GLASGOW, ANGELA LEA CARROLL (CRNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LEA CARROLL
Last Name:GLASGOW
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LEA CARROLL
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1100 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501
Mailing Address - Country:US
Mailing Address - Phone:205-302-9000
Mailing Address - Fax:205-387-8270
Practice Address - Street 1:141 2ND AVE NW
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:AL
Practice Address - Zip Code:35592
Practice Address - Country:US
Practice Address - Phone:205-302-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-141170363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily