Provider Demographics
NPI:1912925603
Name:GLENN, PASQUINEL G (PA)
Entity Type:Individual
Prefix:MRS
First Name:PASQUINEL
Middle Name:G
Last Name:GLENN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18223 WINDING WILLOW OAK WAY
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-8037
Mailing Address - Country:US
Mailing Address - Phone:281-357-0111
Mailing Address - Fax:
Practice Address - Street 1:13300 HARGRAVE RD STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4374
Practice Address - Country:US
Practice Address - Phone:281-357-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004000619363A00000X
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2035487-02Medicaid
TX3034290-01Medicaid
TXP01095021OtherRAIL ROAD MEDICARE
TX890N47OtherBCBS
TX886N28OtherBCBS
TX890N47OtherBCBS
TX318566YVRSMedicare PIN
TXTXB102731Medicare PIN
TXTXB156232Medicare PIN