Healthcare Provider Details

I. General information

NPI: 1063118941
Provider Name (Legal Business Name): GISELLE DICOSTANZO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GISELLE ROBINSON NP

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4218 W MAIN ST
GRAY LA
70359-6408
US

IV. Provider business mailing address

113 SAINT JOSEPH ST
THIBODAUX LA
70301-3612
US

V. Phone/Fax

Practice location:
  • Phone: 985-493-4944
  • Fax: 985-493-4943
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF01230535
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: