Provider Demographics
NPI:1659949600
Name:CELANO, ARIANNA RENEE
Entity Type:Individual
Prefix:
First Name:ARIANNA
Middle Name:RENEE
Last Name:CELANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 TUSCAN RESERVE DR UNIT 533
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-1823
Mailing Address - Country:US
Mailing Address - Phone:630-901-4865
Mailing Address - Fax:
Practice Address - Street 1:201 SIMONE WAY
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-7750
Practice Address - Country:US
Practice Address - Phone:904-829-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL029585003320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029585000Medicaid
FL029585003Medicaid