Healthcare Provider Details

I. General information

NPI: 1336484153
Provider Name (Legal Business Name): ELIZABETH ERIN CHANEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH E CHANEY-RICHARDS NP

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9975 TAVISTOCK LAKES BLVD STE 220
ORLANDO FL
32827-7665
US

IV. Provider business mailing address

9975 TAVISTOCK LAKES BLVD STE 220
ORLANDO FL
32827-7665
US

V. Phone/Fax

Practice location:
  • Phone: 407-930-7801
  • Fax:
Mailing address:
  • Phone: 407-930-7801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11005777
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: