Provider Demographics
NPI:1629672308
Name:BRAGAGNINI, ANDREW (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:BRAGAGNINI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16014 DOCTORS BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1478
Mailing Address - Country:US
Mailing Address - Phone:985-340-7868
Mailing Address - Fax:985-340-7866
Practice Address - Street 1:16014 DOCTORS BLVD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1478
Practice Address - Country:US
Practice Address - Phone:985-340-7868
Practice Address - Fax:985-340-7866
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA324878363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2543911Medicaid