Healthcare Provider Details

I. General information

NPI: 1861002602
Provider Name (Legal Business Name): NINA ANNE CHANDLER APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 01/31/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405 MOREHOUSE DR STE 120
SAN DIEGO CA
92121-4723
US

IV. Provider business mailing address

5405 MOREHOUSE DR STE 120
SAN DIEGO CA
92121-4723
US

V. Phone/Fax

Practice location:
  • Phone: 619-930-9495
  • Fax: 619-790-7393
Mailing address:
  • Phone: 619-930-9495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61126856
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95016363
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00163350
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95186827
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: