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NPI Code Detail

MEDICARE: MRS. NICOLE D CANTERELLA PMHNP, BC

MEDICARE: MRS. NICOLE D CANTERELLA PMHNP, BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner2157992FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508014762
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NICOLE D CANTERELLA PMHNP, BC
Provider Business Mailing Address
First Line : 130 S INDIAN RIVER DR STE 202
Second Line :
City : FORT PIERCE
State : FL
Zip : 34950-4353
Country : US
Telephone Number : 772-773-0229
Fax Number : 772-272-8600
Provider Business Practice Location Address
First Line : 130 S INDIAN RIVER DR STE 202
Second Line :
City : FORT PIERCE
State : FL
Zip : 34950-4353
Country : US
Telephone Number : 772-773-0229
Fax Number : 772-272-8600
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2008
Last Update Date : 05/05/2025

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