Provider Demographics
NPI:1205582327
Name:AQUINO, MALCOLM (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MALCOLM
Middle Name:
Last Name:AQUINO
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10758 PRAIRIE WHEAT CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-8688
Mailing Address - Country:US
Mailing Address - Phone:725-529-4125
Mailing Address - Fax:
Practice Address - Street 1:10758 PRAIRIE WHEAT CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-8688
Practice Address - Country:US
Practice Address - Phone:725-529-4125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV849186363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner