Healthcare Provider Details

I. General information

NPI: 1003770108
Provider Name (Legal Business Name): VICTORIA ELIZABETH GLOCKZIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 US-421
LILLINGTON NC
27546
US

IV. Provider business mailing address

55 VALLEY PINES CIR
SPRING LAKE NC
28390-7191
US

V. Phone/Fax

Practice location:
  • Phone: 910-893-1210
  • Fax:
Mailing address:
  • Phone: 501-749-0576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: