Provider Demographics
NPI:1760365787
Name:VARGOVICH, MITCHELL COLE (APNP)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:COLE
Last Name:VARGOVICH
Suffix:
Gender:M
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4351 W COLLEGE AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-3970
Mailing Address - Country:US
Mailing Address - Phone:920-630-1569
Mailing Address - Fax:
Practice Address - Street 1:GAMEDAY MEN'S HEALTH APPLETON ED AND TRT CLINIC
Practice Address - Street 2:4351 W COLLEGE AVE #130
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914
Practice Address - Country:US
Practice Address - Phone:920-630-1569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1709133363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner