Provider Demographics
NPI:1053988436
Name:NAGLAK, CARYN (FNP)
Entity type:Individual
Prefix:
First Name:CARYN
Middle Name:
Last Name:NAGLAK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MIDWEST EXPRESS CLINIC
Mailing Address - Street 2:1923 W GLEN PARK AVE
Mailing Address - City:GRIFFIN
Mailing Address - State:IN
Mailing Address - Zip Code:46319
Mailing Address - Country:US
Mailing Address - Phone:219-922-2535
Mailing Address - Fax:
Practice Address - Street 1:MIDWEST EXPRESS CLINIC
Practice Address - Street 2:1923 W GLEN PARK AVE
Practice Address - City:GRIFFIN
Practice Address - State:IN
Practice Address - Zip Code:46319
Practice Address - Country:US
Practice Address - Phone:219-922-2535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-05
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.016454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily