Provider Demographics
NPI:1891774899
Name:HALSTEAD, GERALDINE ANN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:ANN
Last Name:HALSTEAD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 PEREGRINE DR
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4776
Mailing Address - Country:US
Mailing Address - Phone:321-777-5796
Mailing Address - Fax:321-777-5796
Practice Address - Street 1:775 MALABAR RD
Practice Address - Street 2:
Practice Address - City:MALABAR
Practice Address - State:FL
Practice Address - Zip Code:32950-3155
Practice Address - Country:US
Practice Address - Phone:321-722-8435
Practice Address - Fax:321-722-8486
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1915812363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics