Healthcare Provider Details

I. General information

NPI: 1821545872
Provider Name (Legal Business Name): ANMARIE CHANDLER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 BRANSCOMB DR SW STE A
JACKSONVILLE AL
36265-3102
US

IV. Provider business mailing address

320 BRANSCOMB DR SW STE A
JACKSONVILLE AL
36265-3102
US

V. Phone/Fax

Practice location:
  • Phone: 256-435-8383
  • Fax: 256-435-8304
Mailing address:
  • Phone: 256-435-8383
  • Fax: 256-435-8304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-113235
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number1-113235
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: