NPIMap

Organization Active NPI

Your Nurse Practitioner PLLC

Doing business as Panacea Behavioral Health & Wellness Center

  • Psychiatric/Mental Health Nurse Practitioner
  • Virginia Beach, VA
National Provider Identifier
1801489711
Registry record updated Jan 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
YOUR NURSE PRACTITIONER PLLC
Doing business as
Panacea Behavioral Health & Wellness Center
Practice address
4360 Shore Dr Ste 101
Virginia Beach, VA 23455-2994
Phone
(757) 251-0879
Fax
(984) 220-9437
NPI assigned
Feb 11, 2021
Last updated
Jan 16, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Sandra W Nichols, PHD, APRN, PMHNP-BCNPI 1770749202
Title
Ceo
Phone
(757) 251-0879

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X
Physician Assistant 363A00000X
Family Nurse Practitioner 363LF0000X
Psychiatric/Mental Health Nurse Practitioner 363LP0808X Primary
Mental Health Counselor 101YM0800X
Clinical Psychologist 103TC0700X
Clinical Social Worker 1041C0700X
Marriage & Family Therapist 106H00000X
Student in an Organized Health Care Education/Training Program 390200000X
Human Factors Occupational Therapist 225XH1300X
Mental Health Occupational Therapist 225XM0800X

Addresses

Primary practice location

4360 Shore Dr Ste 101
Virginia Beach, VA 23455-2994

Mailing address

4360 Shore Dr Ste 101
Virginia Beach, VA 23455-2994
Phone (757) 251-0879

Other practice location 1

1611 E Joy Ln Ste 1
Fort Mohave, AZ 86426-8940
Phone (757) 251-0879

Other practice location 2

857 E Park Ave
Tallahassee, FL 32301-2620
Phone (757) 251-0879

Other names 1

  • Panacea Behavioral Health & Wellness Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, AZ, FL, NC4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20210707003787 VA Part B Supplier - Clinic/Group Practice 7113329517 Receives reassigned benefits from 13 practitioners
Practice locations: Virginia Beach, VA
O20210820001396 AZ Part B Supplier - Clinic/Group Practice 7113329517 Receives reassigned benefits from 2 practitioners
Practice locations: Fort Mohave, AZ
O20260312001371 FL Part B Supplier - Clinic/Group Practice 7113329517 Receives reassigned benefits from 1 practitioner
Practice locations: Tallahassee, FL
O20260327001655 NC Part B Supplier - Clinic/Group Practice 7113329517 Receives reassigned benefits from 2 practitioners
Practice locations: Canton, NC

National Provider Directory

National Provider Directory

Locations

857 E Park Ave
Ste 1
Tallahassee, FL 32301

1700 Pleasure House Rd
Ste 102A
Virginia Beach, VA 23455
Phone (757) 251-0879

4360 Shore Dr
Ste 101
Virginia Beach, VA 23455
Phone (757) 251-0879

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768521600000",
    "number": "1801489711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4360 SHORE DR STE 101",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234552994",
            "telephone_number": "757-251-0879",
            "fax_number": "984-220-9437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4360 SHORE DR STE 101",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234552994",
            "telephone_number": "757-251-0879",
            "fax_number": "984-220-9437"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1611 E Joy Ln Ste 1",
            "address_purpose": "LOCATION",
            "city": "Fort Mohave",
            "state": "AZ",
            "postal_code": "864268940",
            "country_code": "US",
            "telephone_number": "757-251-0879",
            "fax_number": "984-220-9437",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "857 E Park Ave",
            "address_purpose": "LOCATION",
            "city": "Tallahassee",
            "state": "FL",
            "postal_code": "323012620",
            "country_code": "US",
            "telephone_number": "757-251-0879",
            "fax_number": "984-220-9437",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "YOUR NURSE PRACTITIONER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-11",
        "last_updated": "2026-01-16",
        "certification_date": "2026-01-16",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "757-251-0879",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD, APRN, PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XH1300X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Human Factors",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XM0800X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Panacea Behavioral Health & Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.