Doctor Name: | TAMMIE R GLOVER-BROCKINTON |
NPI Number: | 1003218793 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | A004174 |
Business Practice Address: | 4301 W Markham St Little Rock, AR - 722057101 |
Business Phone Number: | 5016867000 |
Business Fax Number: | |
Mailing Address: | 9 Mceuen Dr, GREENBRIER |
State: | AR |
Postal Code: | 720589329 |
Phone Number: | 5019209426 |
Fax Number: | |
NPI Enumeration Date: | 09/24/2014 |
NPI Last Update Date: | 09/24/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | A004174 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |