Healthcare Provider Details

I. General information

NPI: 1215774732
Provider Name (Legal Business Name): NICHOLAS ROBERT CHIAPPONE PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 49TH ST S
GULFPORT FL
33707-5139
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-0001
US

V. Phone/Fax

Practice location:
  • Phone: 727-520-4893
  • Fax: 855-766-6729
Mailing address:
  • Phone: 813-821-8038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11033813
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: