Healthcare Provider Details

I. General information

NPI: 1689362519
Provider Name (Legal Business Name): NANCY GLYNN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. NANCY QUINTANILLA

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14600 SHERMAN WAY STE 300
VAN NUYS CA
91405-2272
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 818-781-7097
  • Fax:
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95024898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: