Provider Demographics
NPI:1578963088
Name:NICHILO, JANE M (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:M
Last Name:NICHILO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 SEMINOLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-7317
Mailing Address - Country:US
Mailing Address - Phone:830-446-9525
Mailing Address - Fax:
Practice Address - Street 1:5400 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-7317
Practice Address - Country:US
Practice Address - Phone:830-446-9525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126283363LP0808X
FL9456593363LP0808X
NC5007428363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health