Provider Demographics
NPI:1992155121
Name:AIZIGOV, IGA (FNP-C)
Entity type:Individual
Prefix:
First Name:IGA
Middle Name:
Last Name:AIZIGOV
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50653 HOLLYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-4947
Mailing Address - Country:US
Mailing Address - Phone:718-208-0510
Mailing Address - Fax:
Practice Address - Street 1:50653 HOLLYBROOK DR
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-4947
Practice Address - Country:US
Practice Address - Phone:718-208-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-19
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28218728A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily