Provider Demographics
NPI:1932687852
Name:JANE M. NICHILO, ARNP, LLC
Entity Type:Organization
Organization Name:JANE M. NICHILO, ARNP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:NICHILO
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:830-446-9525
Mailing Address - Street 1:11795 CAMPHOR WAY
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-5700
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:727-501-3208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9456593163WP0808X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty