| Provider / Organization | NPI | Date Certified |
|---|---|---|
| NICOLE RUSSO CAVIGNARO | 1508527748 | 2024-08-12 |
Nicole Russo Cavignaro is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1508527748. Registration indicates Nicole Russo Cavignaro is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant, ) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (All Other Specialties & Provider Types, ) (Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers)
| Entity Type | Individual |
| Provider Name | Nicole Russo Cavignaro PA-C |
| Practice Office Address | 316 PASEO REYES DR ST AUGUSTINE, FL US |
| Practice Office Telephone | 9045445800 |
| Practice Office Fax | 9045445800 |
| Mailing Address | 316 PASEO REYES DR ST AUGUSTINE, FL 320958464 US |
| Business Telephone | 9045445800 |
| Business Fax | 9045445800 |
| email [] | [email protected] | Direct |
| Code | Practice | License No State |
|---|---|---|
| 363A00000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician AssistantAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Physician Assistant Physician Assistants & Advanced Practice Nursing Providers Physician Assistant All Other Specialties & Provider Types Physician Assistant Physician Assistants & Advanced Practice Nursing Providers | PA9117532
FL |