Provider Demographics
NPI:1730306135
Name:GIARDINA, JERRY F (CRNA)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:F
Last Name:GIARDINA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:PECOS
Mailing Address - State:TX
Mailing Address - Zip Code:79772-7338
Mailing Address - Country:US
Mailing Address - Phone:432-447-3551
Mailing Address - Fax:432-447-5434
Practice Address - Street 1:2323 TEXAS ST
Practice Address - Street 2:
Practice Address - City:PECOS
Practice Address - State:TX
Practice Address - Zip Code:79772-7338
Practice Address - Country:US
Practice Address - Phone:432-447-3551
Practice Address - Fax:432-447-5434
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX458628367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX003467004Medicaid
AZ232634Medicaid
NM20781881Medicaid
CO60232021Medicaid
NM20781881Medicaid
TX003467004Medicaid
8HG572Medicare PIN