Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Glen Eldon Tullous III, FNP-C

Individual provider Family Nurse Practitioner · NPI 1720652167

Mr. Glen Eldon Tullous III, FNP-C is a Nurse Practitioner in Fort Worth, Texas. Qualified in 2020, 6 years ago. Practices with Ppg Health PA, a 30-clinician group and accepts Medicare assignment. Licensed in Texas.

Years since qualifying
6
Licensed in
TX
In the registry since
2021
What do these letters mean?
FNP-C — Family Nurse Practitioner, Certified
A family nurse practitioner certified by the AANP.

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Practice location Address checks out

1001 12th Ave Ste 102
Fort Worth, TX 76104-3926
Phone: (817) 725-7880
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 1023704 (TX)

Record details

NPI number1720652167
Entity typeIndividual (Type 1)
GenderMale
Credentials FNP-C
Sole proprietorNo
NPI enumeratedMay 19, 2021
Last updated in NPPESApril 2, 2025
Certification dateApril 2, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Ppg Health Pa — 30 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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