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 1:402 W BROADWAY STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3554
Mailing Address - Country:US
Mailing Address - Phone:888-777-9409
Mailing Address - Fax:888-999-6614
Practice Address - Street 1:402 W BROADWAY STE 400
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3554
Practice Address - Country:US
Practice Address - Phone:888-777-9409
Practice Address - Fax:888-999-6614
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022579363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health