=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447178611
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLENDA VARGAS RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2026
-----------------------------------------------------
Last Update Date | 07/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4850 SUGARLOAF PKWY STE 101
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30044-2860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-890-0632
-----------------------------------------------------
Fax | 844-772-7366
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2371 MEADOWGLEN TRL
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078-2275
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 762-448-1556
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN214600
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------