Provider Demographics
NPI:1871148973
Name:GLOWACKI, BRENDAN (FNP-BC, CRNP-FAMILY)
Entity type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:
Last Name:GLOWACKI
Suffix:
Gender:M
Credentials:FNP-BC, CRNP-FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 PRINCE FREDERICK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3492
Mailing Address - Country:US
Mailing Address - Phone:410-414-5302
Mailing Address - Fax:443-432-3683
Practice Address - Street 1:985 PRINCE FREDERICK BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3492
Practice Address - Country:US
Practice Address - Phone:410-535-2005
Practice Address - Fax:410-535-4850
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR216694363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD192205000Medicaid