Provider Demographics
NPI:1821472002
Name:NAZARENO, JOCELYN LOVE
Entity Type:Individual
Prefix:MS
First Name:JOCELYN
Middle Name:LOVE
Last Name:NAZARENO
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 1:2016 BLUE IRIS DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-4116
Mailing Address - Country:US
Mailing Address - Phone:623-227-8700
Mailing Address - Fax:
Practice Address - Street 1:600 FULLWOOD RD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-2659
Practice Address - Country:US
Practice Address - Phone:704-841-4920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP15675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist