Healthcare Provider Details

I. General information

NPI: 1760265656
Provider Name (Legal Business Name): JILLIAN NAZARENKO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2454 N MCMULLEN BOOTH RD STE 608
CLEARWATER FL
33759-1337
US

IV. Provider business mailing address

2454 N MCMULLEN BOOTH RD STE 608
CLEARWATER FL
33759-1337
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JILLIAN NAZARENKO
Title or Position: OWNER
Credential:
Phone: 484-222-0067