Healthcare Provider Details

I. General information

NPI: 1104396209
Provider Name (Legal Business Name): GLENDA TRUESDELL COLLINS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 MEDICAL PARK DR STE 300
AIKEN SC
29801-4987
US

IV. Provider business mailing address

690 MEDICAL PARK DR STE 300
AIKEN SC
29801-4987
US

V. Phone/Fax

Practice location:
  • Phone: 800-809-1265
  • Fax:
Mailing address:
  • Phone: 800-809-1265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22337
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP000462
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: