Provider Demographics
NPI:1205498300
Name:GIACHINTA, BREANNA (PA-C)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:GIACHINTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:
Other - Last Name:NEWSOME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37 SAVANNAH LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-7630
Mailing Address - Country:US
Mailing Address - Phone:201-414-7297
Mailing Address - Fax:
Practice Address - Street 1:1055 RIBAUT RD STE 30
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5447
Practice Address - Country:US
Practice Address - Phone:843-476-4702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant