Healthcare Provider Details

I. General information

NPI: 1275622631
Provider Name (Legal Business Name): MICHELE V CHASTAIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 7TH ST N
NAPLES FL
34102-5754
US

IV. Provider business mailing address

350 7TH ST N
NAPLES FL
34102-5754
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-4200
  • Fax: 239-624-4201
Mailing address:
  • Phone: 239-624-4200
  • Fax: 239-624-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN9481595
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: