Provider Demographics
NPI:1396782538
Name:GLENN, TIA RENEE (RN, ANP)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:RENEE
Last Name:GLENN
Suffix:
Gender:F
Credentials:RN, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:18333 EGRET BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3860
Mailing Address - Country:US
Mailing Address - Phone:281-333-9933
Mailing Address - Fax:281-333-4072
Practice Address - Street 1:18333 EGRET BAY BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3860
Practice Address - Country:US
Practice Address - Phone:281-333-9933
Practice Address - Fax:281-333-4072
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX574729363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health