Provider Demographics
NPI:1659751451
Name:COCCIMIGLIO, GINA (DNP, AGPCNP - BC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:COCCIMIGLIO
Suffix:
Gender:F
Credentials:DNP, AGPCNP - BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 SCOOTER LN
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3756
Mailing Address - Country:US
Mailing Address - Phone:801-718-7280
Mailing Address - Fax:833-733-4634
Practice Address - Street 1:1651 SCOOTER LN
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3756
Practice Address - Country:US
Practice Address - Phone:801-718-7280
Practice Address - Fax:833-733-4634
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009817363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health