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General NPI Number Information
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NPI Number | 1669353603
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Entity Type | Individual
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Provider Name | ANDRENA PAULINE GLICK FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 249 S CRAIG ST
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City | BUFFALO
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State | TX
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Zip | 75831-7707
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Country | US
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Telephone | 903-731-5442
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Fax |
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Provider Business Mailing Address
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Address Line | 1620 US HIGHWAY 75 S
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City | BUFFALO
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State | TX
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Zip | 75831-6908
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Country | US
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Telephone | 903-388-1219
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1211187
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP1211187
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License Number State | TX
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