Jade Nycole Aguilar
Individual provider Active NPI Athletic Trainer · Portage, IN
NPI 1790251981 · NPPES record last updated Oct 16, 2018
Key facts
- NPI
- 1790251981
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 5945 Waterside Dr Apt 2
Portage, IN 46368-4933 - Phone
- (219) 617-7855
- NPI assigned
- Oct 16, 2018
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Athletic Trainer | 2255A2300X | Yes |
Addresses
Primary practice location
5945 Waterside Dr Apt 2
Portage, IN 46368-4933
Mailing address
5945 Waterside Dr Apt 2
Portage, IN 46368-4933
Phone (219) 617-7855
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NONE | Other | NONE |
Other providers in Portage, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.