Provider Demographics
NPI:1417843640
Name:CACCIOLA, GIANNA NICOLE (RN)
Entity type:Individual
Prefix:MISS
First Name:GIANNA
Middle Name:NICOLE
Last Name:CACCIOLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 TACONIC CT
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-2331
Mailing Address - Country:US
Mailing Address - Phone:631-603-8128
Mailing Address - Fax:
Practice Address - Street 1:197 HALF HOLLOW RD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5859
Practice Address - Country:US
Practice Address - Phone:631-370-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY961335163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & AdolescentGroup - Single Specialty