Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP122739 | TX |
NPI | 1003160532 |
---|---|
Provider Name | Maria Sybil Gagliano |
First Address | Fort Worth, TX 76132-4116 |
Second Address | Fort Worth, TX 76132-4116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2012 |
Last Update Date | 16/10/2018 |