Provider Demographics
NPI:1114632692
Name:MIRAGLILO, MARY ELLEN (APN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:MIRAGLILO
Suffix:
Gender:F
Credentials:APN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 INFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1944
Mailing Address - Country:US
Mailing Address - Phone:609-675-1589
Mailing Address - Fax:
Practice Address - Street 1:443 SHORE RD STE 103
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2645
Practice Address - Country:US
Practice Address - Phone:609-569-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01423800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily