Provider Demographics
NPI:1770090102
Name:MINGILINO, SCOTT D (FNP-BC, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:MINGILINO
Suffix:
Gender:M
Credentials:FNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 77TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-4104
Mailing Address - Country:US
Mailing Address - Phone:262-649-5303
Mailing Address - Fax:262-315-1700
Practice Address - Street 1:12001 BRAUN RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53177-3349
Practice Address - Country:US
Practice Address - Phone:262-942-2780
Practice Address - Fax:414-385-1549
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7989-33363L00000X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100074157Medicaid