Healthcare Provider Details

I. General information

NPI: 1558068452
Provider Name (Legal Business Name): VARGAS NINO HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MITCHELL ST STE B
MILLSBORO DE
19966-9402
US

IV. Provider business mailing address

35244 ACADIA LN
LEWES DE
19958-5846
US

V. Phone/Fax

Practice location:
  • Phone: 443-235-3875
  • Fax:
Mailing address:
  • Phone: 302-853-0268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANA VARGAS
Title or Position: SOLE MEMBER
Credential: FNP
Phone: 443-235-3875