Healthcare Provider Details

I. General information

NPI: 1356998611
Provider Name (Legal Business Name): HEATHER LYNNETTE CHANDLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 DON WICKHAM DR
CLERMONT FL
34711-1979
US

IV. Provider business mailing address

1900 DON WICKHAM DR
CLERMONT FL
34711-1979
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-3220
  • Fax: 321-843-3210
Mailing address:
  • Phone: 321-843-3220
  • Fax: 321-843-3210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11003097
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: