Provider Demographics
NPI:1609817188
Name:LEGGIO, NICOLE ANN (RPA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:LEGGIO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 GUY LOMBARDO AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520
Mailing Address - Country:US
Mailing Address - Phone:516-377-8014
Mailing Address - Fax:516-377-8017
Practice Address - Street 1:60 GUY LOMBARDO AVE
Practice Address - Street 2:JACQUELINE DELMONT MD PC
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520
Practice Address - Country:US
Practice Address - Phone:516-377-8014
Practice Address - Fax:516-377-8017
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011014363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011014OtherLICENSE
NY011014OtherLICENSE