Healthcare Provider Details

I. General information

NPI: 1114530664
Provider Name (Legal Business Name): COMPLEX CARE OF CENTRAL FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 02/26/2023
Certification Date: 02/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 SWEETWATER CLUB CIR
LONGWOOD FL
32779-2131
US

IV. Provider business mailing address

508 SWEETWATER CLUB CIR
LONGWOOD FL
32779-2131
US

V. Phone/Fax

Practice location:
  • Phone: 407-463-5848
  • Fax:
Mailing address:
  • Phone: 407-463-5848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTIAN A CHABAN
Title or Position: OWNER
Credential: MD
Phone: 407-463-5848