Healthcare Provider Details

I. General information

NPI: 1366394124
Provider Name (Legal Business Name): JESSICA CHIVLEATTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6256 APPLE SNAIL AVE
NEW PORT RICHEY FL
34653-4704
US

IV. Provider business mailing address

6256 APPLE SNAIL AVE
NEW PORT RICHEY FL
34653-4704
US

V. Phone/Fax

Practice location:
  • Phone: 727-645-7202
  • Fax:
Mailing address:
  • Phone: 727-645-7202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11045690
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: