Healthcare Provider Details

I. General information

NPI: 1104251776
Provider Name (Legal Business Name): ANTHONY ERIK GLYDWELL FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HIGHWAY 76
CLARKSVILLE TN
37043-8405
US

IV. Provider business mailing address

1000 HIGHWAY 76
CLARKSVILLE TN
37043-8405
US

V. Phone/Fax

Practice location:
  • Phone: 931-245-1150
  • Fax:
Mailing address:
  • Phone: 931-245-1150
  • Fax: 931-289-2453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number39135
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: