Provider Demographics
NPI:1275748774
Name:GIGLIOTTI, WENDY J (CRNA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:J
Last Name:GIGLIOTTI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:G
Other - Last Name:JACKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:360 FAIRWAYS DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220-8776
Mailing Address - Country:US
Mailing Address - Phone:850-525-1026
Mailing Address - Fax:
Practice Address - Street 1:360 FAIRWAYS DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31220-8776
Practice Address - Country:US
Practice Address - Phone:850-525-1026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN162778367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered