Provider Demographics
NPI:1891819900
Name:MARGAGLIO, TERESA M (NP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:MARGAGLIO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 STEINER RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6005
Mailing Address - Country:US
Mailing Address - Phone:337-984-7403
Mailing Address - Fax:
Practice Address - Street 1:1555 GARY DR STE C
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-3448
Practice Address - Country:US
Practice Address - Phone:337-332-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA29626-1197363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1671002Medicaid
LA1671002Medicaid