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General NPI Number Information
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NPI Number | 1932687852
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Entity Type | Organization
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Legal Business Name | JANE M. NICHILO, ARNP, LLC
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Dates
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Enumeration Date | 08/02/2018
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Last Update Date | 08/02/2018
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Provider Practice Location Address
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Address Line | 5400 SEMINOLE BLVD
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City | SEMINOLE
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State | FL
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Zip | 33772-7317
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Country | US
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Telephone | 727-501-3208
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Fax |
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Provider Business Mailing Address
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Address Line | 11795 CAMPHOR WAY
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City | SEMINOLE
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State | FL
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Zip | 33772-5700
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Country | US
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Telephone | 830-446-9525
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Fax |
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Authorized Official
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Title or Position | PMHNP-BC
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Name | MRS. JANE M NICHILO
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Credential | ARNP
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Telephone | 830-446-9525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 9456593
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License Number State | FL
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