Provider Demographics
NPI:1790183499
Name:GIRARDEAU, YASMEEN (CRNP)
Entity Type:Individual
Prefix:
First Name:YASMEEN
Middle Name:
Last Name:GIRARDEAU
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11850 W MARKET PL
Mailing Address - Street 2:SUITE P
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2670
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:240-485-5407
Practice Address - Street 1:1700 HOSPITAL SOUTH DR
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-6810
Practice Address - Country:US
Practice Address - Phone:770-819-9211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC001460363LX0001X
GARN277326363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD994LMedicare UPIN
MD412318YYKMedicare PIN