Provider Demographics
NPI:1861032732
Name:AGUILAR, ABIGAIL (FNP-C)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62440 VAUGHAN DR
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MO
Mailing Address - Zip Code:65018-3123
Mailing Address - Country:US
Mailing Address - Phone:573-645-3244
Mailing Address - Fax:
Practice Address - Street 1:1511 CHRISTY DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-2854
Practice Address - Country:US
Practice Address - Phone:573-632-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019047674363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily