Provider Demographics
NPI:1518128230
Name:GERARDI, STACEY ANN (CRNA)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:ANN
Last Name:GERARDI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:ANN
Other - Last Name:FRANCESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2508 SW CAMEO BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2930
Mailing Address - Country:US
Mailing Address - Phone:772-785-9803
Mailing Address - Fax:
Practice Address - Street 1:421 SE OSCEOLA ST
Practice Address - Street 2:SUITE 3
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2505
Practice Address - Country:US
Practice Address - Phone:772-286-0338
Practice Address - Fax:772-287-1139
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLANT2729002367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG4588OtherBXFL
FL000178800Medicaid
FL77336OtherMEDICARE GROUP
FLAL565ZMedicare Oscar/Certification