MEDICARE: NADINE D. MASSILLON ARNP

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	363LF0000X	Family Nurse Practitioner	APRN9455859	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN9455859	FL

General Provider Information

NPI Number	:	1760966915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADINE D. MASSILLON ARNP

Provider Business Mailing Address
First Line	:	5979 VINELAND RD STE 109
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-7857
Country	:	US
Telephone Number	:	407-270-7702
Fax Number	:	407-270-7705

Provider Business Practice Location Address
First Line	:	5979 VINELAND RD STE 109
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-7857
Country	:	US
Telephone Number	:	407-270-7702
Fax Number	:	407-270-7702

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

Provider Enumeration Date	:	09/23/2018
Last Update Date	:	05/09/2024

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