Healthcare Provider Details

I. General information

NPI: 1649437401
Provider Name (Legal Business Name): NELSON ANTONIO PICHARDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 WOODBRIAR DR
SANTA ROSA BEACH FL
32459
US

IV. Provider business mailing address

253 WOODBRIAR DR
SANTA ROSA BEACH FL
32459-0617
US

V. Phone/Fax

Practice location:
  • Phone: 850-460-5543
  • Fax:
Mailing address:
  • Phone: 850-460-0959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberME113342
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME113342
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME113342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: