Basic Information
Provider Information
NPI: 1245414747
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GERACI
FirstName: MARIA
MiddleName: CATHERINE
NamePrefix: MISS
NameSuffix:  
Credential: RN MSN ARNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 700 8TH AVE W STE 101
Address2:  
City: PALMETTO
State: FL
PostalCode: 342214737
CountryCode: US
TelephoneNumber: 9417764000
FaxNumber: 9418454963
Practice Location
Address1: 725 N 12TH AVE BLDG B
Address2:  
City: ARCADIA
State: FL
PostalCode: 342668752
CountryCode: US
TelephoneNumber: 8634941242
FaxNumber: 8634910466
Other Information
ProviderEnumerationDate: 12/20/2007
LastUpdateDate: 03/14/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0808XARNP9314896FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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