Individual
DR. NICHOLAS G. BAGNOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1220 SLIGH BLVD, ORLANDO, FL 32806-1108
(407) 210-4251
(407) 648-0968
Mailing address
3869 WINDERLAKES DR, ORLANDO, FL 32835-2625
(407) 210-4251
(407) 648-0968
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
OS7417
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
252446500
—
FL
01
—
3123096
AETNA
FL
01
—
57552
BCBS
FL
01
—
7848047011
CIGNA
FL
Enumeration date
05/22/2006
Last updated
02/01/2008
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