Provider Demographics
NPI:1518559103
Name:BAGLIETTO, ALBA MARINA (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ALBA
Middle Name:MARINA
Last Name:BAGLIETTO
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18505 NW 75 PLACE SUITE 105
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3611
Mailing Address - Country:US
Mailing Address - Phone:305-456-5029
Mailing Address - Fax:
Practice Address - Street 1:18505 NW 75 PLACE SUITE 105
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33015-3611
Practice Address - Country:US
Practice Address - Phone:305-456-5029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009815363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care