Provider Demographics
NPI:1083019111
Name:CHIARELLO, NANCY (DO)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:CHIARELLO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 OCEANWALK DR S
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-4678
Mailing Address - Country:US
Mailing Address - Phone:904-249-5673
Mailing Address - Fax:
Practice Address - Street 1:174 OCEANWALK DR S
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:FL
Practice Address - Zip Code:32233-4678
Practice Address - Country:US
Practice Address - Phone:904-249-5673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS78172084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine