Provider Demographics
NPI:1043761042
Name:GARGANO, KYLIE (APRN)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:GARGANO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 CLAPBOARD HILL RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2200
Mailing Address - Country:US
Mailing Address - Phone:203-789-2255
Mailing Address - Fax:
Practice Address - Street 1:326 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2560
Practice Address - Country:US
Practice Address - Phone:203-878-4312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6775363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner