Provider Demographics
NPI:1265263065
Name:SIGNATURE PROVIDERS NURSING CORP
Entity type:Organization
Organization Name:SIGNATURE PROVIDERS NURSING CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:AGANYA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:888-848-4364
Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-0392
Mailing Address - Country:US
Mailing Address - Phone:888-848-4364
Mailing Address - Fax:
Practice Address - Street 1:1690 W SHAW AVE STE 220
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3519
Practice Address - Country:US
Practice Address - Phone:888-848-4364
Practice Address - Fax:833-218-8844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1366270621Medicaid