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NPI Code Detail

MEDICARE: MS. DARLA L BAGWELL ARNP

MEDICARE: MS. DARLA L BAGWELL ARNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse PractitionerARNP3016352FL

General Provider Information

NPI Number : 1801884028
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DARLA L BAGWELL ARNP
Provider Business Mailing Address
First Line : 356 E MIDWAY RD
Second Line :
City : FORT PIERCE
State : FL
Zip : 34982-7148
Country : US
Telephone Number : 772-464-9746
Fax Number :
Provider Business Practice Location Address
First Line : 356 E MIDWAY RD
Second Line :
City : FORT PIERCE
State : FL
Zip : 34982-7148
Country : US
Telephone Number : 772-464-9746
Fax Number : 772-464-9750
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2005
Last Update Date : 05/17/2013

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