Provider Demographics
NPI:1881014546
Name:GIARDINA, STACEY L
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:GIARDINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:G
Other - Last Name:SUTTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1539 VIOLA ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-8353
Mailing Address - Country:US
Mailing Address - Phone:504-715-0345
Mailing Address - Fax:
Practice Address - Street 1:2703 GENERAL DEGAULLE DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-6222
Practice Address - Country:US
Practice Address - Phone:504-488-1888
Practice Address - Fax:504-754-7552
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07756363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health