Healthcare Provider Details

I. General information

NPI: 1104835669
Provider Name (Legal Business Name): JOSEPH AQUILINA FNPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SOMERSET ST SUITE 2
MILLINOCKET ME
04462-1258
US

IV. Provider business mailing address

PO BOX 99
LINCOLN ME
04457-0099
US

V. Phone/Fax

Practice location:
  • Phone: 207-794-6700
  • Fax: 207-794-6777
Mailing address:
  • Phone: 207-794-6700
  • Fax: 207-794-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP81577
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: