Provider Demographics
NPI:1174992085
Name:AGUINALDO, JANICE ANN (ARNP)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:ANN
Last Name:AGUINALDO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 CORPORATE CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7760
Mailing Address - Country:US
Mailing Address - Phone:702-910-3950
Mailing Address - Fax:
Practice Address - Street 1:653 N TOWN CENTER DR STE 106
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0515
Practice Address - Country:US
Practice Address - Phone:702-844-4842
Practice Address - Fax:702-844-4845
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAPRN002033OtherNV LICENSE
NV1174992085Medicaid