Healthcare Provider Details

I. General information

NPI: 1275224651
Provider Name (Legal Business Name): PATRICIA UCHENNA CHUKWU PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MAITLAND CENTER PKWY STE 310
MAITLAND FL
32751-7442
US

IV. Provider business mailing address

1733 AMARYLLIS CIRCLE
ORLANDO FL
32825
US

V. Phone/Fax

Practice location:
  • Phone: 407-426-4800
  • Fax: 407-426-4820
Mailing address:
  • Phone: 407-466-7752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11026169
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11026169
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: