Provider Demographics
NPI:1275783128
Name:BAGGIO, KIMBERLY (PNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BAGGIO
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 MARCUS AVENUE
Mailing Address - Street 2:SUITE M18
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:516-466-6953
Mailing Address - Fax:516-466-5608
Practice Address - Street 1:1999 MARCUS AVENUE
Practice Address - Street 2:SUITE M18
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-466-6953
Practice Address - Fax:516-466-5608
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382013363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics