Provider Demographics
NPI:1255495222
Name:GLAZE, JOANNA N (WHCNP)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:N
Last Name:GLAZE
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:802 HOPKINS ST FL 2
Practice Address - Street 2:GARLAND WOMEN'S HEALTH CENTER
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-7379
Practice Address - Country:US
Practice Address - Phone:214-266-0780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX582532363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137777210Medicaid
TX137777212Medicaid
TX137777216Medicaid
TX137777218Medicaid
TX137777219Medicaid
TX137777215Medicaid
TX137777214Medicaid
TX137777217Medicaid
TX137777211Medicaid
TX137777213Medicaid
TX137777216Medicaid