Provider Demographics
NPI:1689362519
Name:GLYNN, NANCY (NP)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:GLYNN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:QUINTANILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-579-3203
Mailing Address - Fax:
Practice Address - Street 1:7438 KRAFT AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-3320
Practice Address - Country:US
Practice Address - Phone:818-644-7667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024898207Q00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine