Provider Demographics
NPI:1982172003
Name:BELLISARIO, NICOLE E (DNP, PMHNP-BC, CNL)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:E
Last Name:BELLISARIO
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC, CNL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25108 MARGUERITE PKWY STE A-321
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-2497
Mailing Address - Country:US
Mailing Address - Phone:888-777-9409
Mailing Address - Fax:
Practice Address - Street 1:25108 MARGUERITE PKWY STE A-321
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-2497
Practice Address - Country:US
Practice Address - Phone:888-777-9409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022579363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health