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NPI Code Detail

MEDICARE: MRS. GLENDA ROSE HAGMAN PA

MEDICARE: MRS. GLENDA ROSE HAGMAN PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA04946TX
2363A00000XPhysician AssistantPA04946TX

General Provider Information

NPI Number : 1427144518
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GLENDA ROSE HAGMAN PA
Provider Business Mailing Address
First Line : 1000 LIPSCOMB ST STE 110
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3181
Country : US
Telephone Number : 817-348-8600
Fax Number : 817-348-8602
Provider Business Practice Location Address
First Line : 1000 LIPSCOMB ST STE 110
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3181
Country : US
Telephone Number : 817-348-8600
Fax Number : 817-348-8602
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2006
Last Update Date : 09/02/2025

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Directions to “ MRS. GLENDA ROSE HAGMAN PA” Practice Location

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