Healthcare Provider Details

I. General information

NPI: 1932687852
Provider Name (Legal Business Name): JANE M. NICHILO, ARNP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 SEMINOLE BLVD
SEMINOLE FL
33772-7317
US

IV. Provider business mailing address

11795 CAMPHOR WAY
SEMINOLE FL
33772-5700
US

V. Phone/Fax

Practice location:
  • Phone: 727-501-3208
  • Fax:
Mailing address:
  • Phone: 830-446-9525
  • Fax: 727-392-2977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number9456593
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANE M NICHILO
Title or Position: PMHNP-BC
Credential: ARNP
Phone: 830-446-9525