Individual provider Active NPI

Nicole Renee' Glasco, FNP-C

  • Family Nurse Practitioner
  • Tyler, TX
National Provider Identifier
1346902517
Registry record updated Nov 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1141016 Issued in TX
Practice address
1783 Troup Hwy
Tyler, TX 75701-5869
Phone
(903) 595-2283
NPI assigned
Oct 6, 2021
Last updated
Nov 6, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1141016 TX Primary

Addresses

Primary practice location

1783 Troup Hwy
Tyler, TX 75701-5869

Mailing address

15792 County Road 472
Tyler, TX 75706-4035
Phone (903) 293-8343

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240320000526 TX Practitioner - Nurse Practitioner 6204273717 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christus Trinity Clinic TexasGroup PAC ID 3072426741, 1,540 clinicians

Practice addresses (Care Compare)

105 Zeid Blvd
Henderson, TX 75652-6070
Phone (903) 595-2283

1108 S Buffalo St
Canton, TX 75103-2304
Phone (903) 595-2283

1302 N Pacific St
Christus Trinity Clinic
Mineola, TX 75773-1022
Phone (903) 569-5383

1783 Troup Hwy
Tyler, TX 75701-5869
Phone (903) 595-2283

18780 Interstate 20
Canton, TX 75103-3593
Phone (903) 567-4841

5321 S FM
14 Christus Trinity Clinic
Holly Lake Ranch, TX 75765-4839
Phone (903) 769-2990

620 S Fleishel Ave
Christus Trinity Clinic
Tyler, TX 75701-2041
Phone (903) 606-4900

630 S Fleishel Ave
Tyler, TX 75701-2041
Phone (903) 606-5560

650 E Lennon Dr
Christus Trinity Clinic
Emory, TX 75440-3227
Phone (903) 473-7234

PO Box
Suite 846098
Dallas, TX 75284-6098

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Trinity Clinic Texas CurrentSince May 6, 2024 Accepting new patients
Christus Trinity Clinic Texas CurrentSince May 6, 2024 Accepting new patients

Locations

1783 Troup Hwy
Tyler, TX 75701
Phone 90359522832057

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

Interoperability endpoints

  • Direct secure messaging: nglasco357411@christushealth.direct-ci.net

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730851200000",
    "number": "1346902517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15792 COUNTY ROAD 472",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757064035",
            "telephone_number": "903-293-8343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1783 TROUP HWY",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757015869",
            "telephone_number": "903-595-2283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLASCO",
        "first_name": "NICOLE",
        "middle_name": "RENEE'",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-06",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1141016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.