Provider Demographics
NPI:1720852874
Name:DERRICO, GIA
Entity Type:Individual
Prefix:
First Name:GIA
Middle Name:
Last Name:DERRICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GIA
Other - Middle Name:
Other - Last Name:D'ERRICO-PLANER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:749 BEACH DR # 9
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-1620
Mailing Address - Country:US
Mailing Address - Phone:702-292-4422
Mailing Address - Fax:
Practice Address - Street 1:749 BEACH DR # 9
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-1620
Practice Address - Country:US
Practice Address - Phone:702-292-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA97758251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health