Provider Demographics
NPI:1407427248
Name:GAUDIOSO, GEORGIA MARIE (RN, FNP)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:MARIE
Last Name:GAUDIOSO
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:MS
Other - First Name:GEORGIA
Other - Middle Name:MARIE
Other - Last Name:GAUDIOSO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:354 SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5142
Mailing Address - Country:US
Mailing Address - Phone:760-415-4768
Mailing Address - Fax:
Practice Address - Street 1:173 AVOCADO ST
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1007
Practice Address - Country:US
Practice Address - Phone:760-415-4768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019067363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA729443Medicaid