Healthcare Provider Details

I. General information

NPI: 1851789192
Provider Name (Legal Business Name): ANNA JOSE ELISSENDA CHANOINE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date: 02/17/2026
Reactivation Date: 02/24/2026

III. Provider practice location address

1987 S US HIGHWAY 1
FORT PIERCE FL
34950-5147
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 772-468-5925
  • Fax: 772-466-6588
Mailing address:
  • Phone: 305-500-2000
  • Fax: 772-466-6588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN828
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number18967
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: