Healthcare Provider Details

I. General information

NPI: 1730306135
Provider Name (Legal Business Name): JERRY F GIARDINA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 TEXAS ST
PECOS TX
79772-7338
US

IV. Provider business mailing address

2323 TEXAS ST
PECOS TX
79772-7338
US

V. Phone/Fax

Practice location:
  • Phone: 432-447-3551
  • Fax: 432-447-5434
Mailing address:
  • Phone: 432-447-3551
  • Fax: 432-447-5434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number458628
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: