Healthcare Provider Details

I. General information

NPI: 1427985621
Provider Name (Legal Business Name): BRYCE CHANDLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 EWING AVE
CLEARWATER FL
33756-3407
US

IV. Provider business mailing address

1221 EWING AVE
CLEARWATER FL
33756-3407
US

V. Phone/Fax

Practice location:
  • Phone: 727-449-2599
  • Fax:
Mailing address:
  • Phone: 727-449-2599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9121490
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: