Provider Demographics
NPI:1760966915
Name:MASSILLON, NADINE D (ARNP)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:D
Last Name:MASSILLON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5979 VINELAND RD STE 109
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7857
Mailing Address - Country:US
Mailing Address - Phone:407-270-7702
Mailing Address - Fax:407-270-7705
Practice Address - Street 1:5979 VINELAND RD STE 109
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7857
Practice Address - Country:US
Practice Address - Phone:407-270-7702
Practice Address - Fax:407-270-7702
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-23
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9455859363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty