MEDICARE: ERICK NAZARENO PA-C

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
1	363A00000X	Physician Assistant	50.008396RX	OH

General Provider Information

NPI Number	:	1720761513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICK NAZARENO PA-C

Provider Business Mailing Address
First Line	:	2253 OLYMPIC ST STE B
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45503-2736
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	817 S GETTYSBURG AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417-3517
Country	:	US
Telephone Number	:	937-294-3603
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2023
Last Update Date	:	10/02/2025

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