Healthcare Provider Details

I. General information

NPI: 1144376088
Provider Name (Legal Business Name): CARRIE M CHAPMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 GATEWAY DR STE 2A
MELBOURNE FL
32901-2607
US

IV. Provider business mailing address

3300 S. FISKE BLVD. CREDENTIALING
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-9230
  • Fax: 321-434-8229
Mailing address:
  • Phone: 321-434-9230
  • Fax: 321-951-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: