Provider Demographics
NPI:1518904440
Name:BRIGUGLIO, PRISCILLA E (PA-C)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:E
Last Name:BRIGUGLIO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4135 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9803
Mailing Address - Country:US
Mailing Address - Phone:330-286-5330
Mailing Address - Fax:330-286-5396
Practice Address - Street 1:7067 TIFFANY BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-1993
Practice Address - Country:US
Practice Address - Phone:330-758-2748
Practice Address - Fax:330-758-3282
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-12-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH50001657363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000513025OtherANTHEM
OHBRPA17862OtherMEDICARE PTAN
OHP00694940OtherMEDICARE RAILROAD
OHP00694940OtherMEDICARE RAILROAD