MEDICARE: NICOLE CHIARANON CHAN

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	95030507	CA

General Provider Information

NPI Number	:	1841027208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE CHIARANON CHAN

Provider Business Mailing Address
First Line	:	115 N EL CAMINO REAL STE A
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92058-1844
Country	:	US
Telephone Number	:	760-330-5055
Fax Number	:	760-542-2026

Provider Business Practice Location Address
First Line	:	115 N EL CAMINO REAL STE A
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92058-1844
Country	:	US
Telephone Number	:	760-330-5055
Fax Number	:	760-542-2026

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

Provider Enumeration Date	:	09/18/2024
Last Update Date	:	04/16/2026

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Directions to “ NICOLE CHIARANON CHAN ” Practice Location

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