Provider Demographics
NPI:1275891699
Name:VIGLIANCO, ROBIN G (NP)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:G
Last Name:VIGLIANCO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15200 COMMUNITY RD
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3085
Mailing Address - Country:US
Mailing Address - Phone:228-575-7243
Mailing Address - Fax:228-575-7420
Practice Address - Street 1:15200 COMMUNITY RD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3085
Practice Address - Country:US
Practice Address - Phone:228-575-7243
Practice Address - Fax:228-575-7420
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSF0412050363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner