Basic Information
| Provider Information | |||||||||
| NPI: | 1477285864 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGUINAGA | ||||||||
| FirstName: | MARIO | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | AGACNP-DNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3581 GAINES MILL RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305078073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786291626 | ||||||||
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| Practice Location | |||||||||
| Address1: | 199 PRINCE AVE | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306012400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064757000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2022 | ||||||||
| LastUpdateDate: | 06/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | RN269637 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | RN269637 | 01 | GA | GEORGIA BOARD OF NURSING | OTHER |