Healthcare Provider Details

I. General information

NPI: 1659751451
Provider Name (Legal Business Name): GINA COCCIMIGLIO DNP, AGPCNP - BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 SCOOTER LN
FALLBROOK CA
92028-3756
US

IV. Provider business mailing address

1651 SCOOTER LN
FALLBROOK CA
92028-3756
US

V. Phone/Fax

Practice location:
  • Phone: 801-718-7280
  • Fax: 833-733-4634
Mailing address:
  • Phone: 801-718-7280
  • Fax: 833-733-4634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95009817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: