Healthcare Provider Details

I. General information

NPI: 1528687431
Provider Name (Legal Business Name): JILLIAN NAZARENKO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILLIAN SANDERSON

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 ESTANCIA BLVD STE 106
CLEARWATER FL
33761-2607
US

IV. Provider business mailing address

2430 ESTANCIA BLVD STE 106
CLEARWATER FL
33761-2607
US

V. Phone/Fax

Practice location:
  • Phone: 484-222-0067
  • Fax:
Mailing address:
  • Phone: 484-222-0067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: