Healthcare Provider Details

I. General information

NPI: 1912638487
Provider Name (Legal Business Name): TYLER GLASSFORD FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1863 EAST FLORENCE BLVD
CASA GRANDE AZ
85122
US

IV. Provider business mailing address

PO BOX 96395
PHOENIX AZ
85072-6395
US

V. Phone/Fax

Practice location:
  • Phone: 520-836-3446
  • Fax:
Mailing address:
  • Phone: 520-836-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number278544
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11217804-3102
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number11217804-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: