MEDICARE: SHIRLEY JOHANNA CHACON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	227900000X	Registered Respiratory Therapist	RT13837	FL

General Provider Information

NPI Number	:	1619544814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY JOHANNA CHACON

Provider Business Mailing Address
First Line	:	4525 LA CAPRI CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-2334
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4525 LA CAPRI CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-2334
Country	:	US
Telephone Number	:	813-562-9279
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2021
Last Update Date	:	06/07/2021

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Directions to “ SHIRLEY JOHANNA CHACON ” Practice Location

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