Provider Demographics
NPI:1437132875
Name:GAGLIANO, NICOLE M (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:M
Last Name:GAGLIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:GAGLIANO
Other - Last Name:BUDDENDORFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:550 E STATE ROAD 434
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5222
Mailing Address - Country:US
Mailing Address - Phone:407-261-2917
Mailing Address - Fax:407-262-5718
Practice Address - Street 1:550 E STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5222
Practice Address - Country:US
Practice Address - Phone:407-261-2917
Practice Address - Fax:407-262-5718
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78672208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274249700Medicaid