Provider Demographics
NPI:1689038101
Name:FAGIOLO, ELIZABETH MARIE (FNP, AG-ACNP-BC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:FAGIOLO
Suffix:
Gender:F
Credentials:FNP, AG-ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W BUSINESS LOOP 70 STE 275
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2522
Mailing Address - Country:US
Mailing Address - Phone:573-874-0008
Mailing Address - Fax:573-875-5350
Practice Address - Street 1:601 W BUSINESS LOOP 70 STE 275
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2522
Practice Address - Country:US
Practice Address - Phone:573-874-0008
Practice Address - Fax:573-875-5350
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016028014363LG0600X
MO2016028015363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology