Provider Demographics
NPI:1447985072
Name:CHICKERELLA, VINCE (FNP, CNP)
Entity type:Individual
Prefix:
First Name:VINCE
Middle Name:
Last Name:CHICKERELLA
Suffix:
Gender:M
Credentials:FNP, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 VISTA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-7068
Mailing Address - Country:US
Mailing Address - Phone:614-557-8726
Mailing Address - Fax:
Practice Address - Street 1:7100 GRAPHICS WAY STE 2400
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-0208
Practice Address - Country:US
Practice Address - Phone:740-953-4100
Practice Address - Fax:740-953-4173
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0031847363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty