Healthcare Provider Details

I. General information

NPI: 1750115010
Provider Name (Legal Business Name): VINITABEN BALDEVBHAI CHAUDHARI FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3813 ROSS CLARK CIR STE 300
DOTHAN AL
36303-2881
US

IV. Provider business mailing address

107 VIXEN CT
DOTHAN AL
36305-9353
US

V. Phone/Fax

Practice location:
  • Phone: 334-479-0505
  • Fax:
Mailing address:
  • Phone: 850-272-9052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11034972
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: