Provider Demographics
NPI:1467445718
Name:GULINO, STACI S (MSN, APRN-BC, PMHNP)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:S
Last Name:GULINO
Suffix:
Gender:F
Credentials:MSN, APRN-BC, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HIDDEN OAK LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-3010
Mailing Address - Country:US
Mailing Address - Phone:225-769-6567
Mailing Address - Fax:
Practice Address - Street 1:9311A BLUEBONNET BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2806
Practice Address - Country:US
Practice Address - Phone:225-769-5551
Practice Address - Fax:225-769-5583
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05646363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health