Provider Demographics
NPI:1861002602
Name:CHANDLER, NINA ANNE (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:ANNE
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 MOREHOUSE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4723
Mailing Address - Country:US
Mailing Address - Phone:619-930-9495
Mailing Address - Fax:
Practice Address - Street 1:5405 MOREHOUSE DR STE 120
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4723
Practice Address - Country:US
Practice Address - Phone:619-930-9495
Practice Address - Fax:619-790-7393
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00163350163W00000X
CARN95186827163W00000X
WAAP61126856363LP0808X
CA95016363363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse