Healthcare Provider Details

I. General information

NPI: 1457754848
Provider Name (Legal Business Name): STACI PITARRO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 GREENBRIER BLVD
COVINGTON LA
70433-7236
US

IV. Provider business mailing address

PO BOX 957
MADISONVILLE LA
70447-0957
US

V. Phone/Fax

Practice location:
  • Phone: 985-893-2970
  • Fax:
Mailing address:
  • Phone: 985-771-2221
  • Fax: 844-713-8349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08042
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: