Basic Information
| Provider Information | |||||||||
| NPI: | 1962424093 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIAMALVA | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | ADAM | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | FNPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3513 COURTENAY CIR | ||||||||
| Address2: | |||||||||
| City: | OCEAN SPRINGS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395643401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2288185589 | ||||||||
| FaxNumber: | 2285235731 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 VETERANS AVE | ||||||||
| Address2: | |||||||||
| City: | BILOXI | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395312410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2285235000 | ||||||||
| FaxNumber: | 2285235731 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R807638 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.