Provider Demographics
NPI:1194064287
Name:AGUIAR, MARK J (RN, MSN)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:AGUIAR
Suffix:
Gender:M
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MEDICAL GROUP
Mailing Address - Street 2:UNIT 5142, BLDG 626
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96368
Mailing Address - Country:US
Mailing Address - Phone:314-884-2191
Mailing Address - Fax:
Practice Address - Street 1:18 MEDICAL GROUP
Practice Address - Street 2:UNIT 5142, BLDG 626
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96368
Practice Address - Country:US
Practice Address - Phone:314-884-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX667240363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics