Healthcare Provider Details

I. General information

NPI: 1205981602
Provider Name (Legal Business Name): RHONDA LYNN CHADWELL P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 UNIVERSITY PKWY STE 306
PENSACOLA FL
32514-5752
US

IV. Provider business mailing address

PO BOX 553
CANTONMENT FL
32533-0553
US

V. Phone/Fax

Practice location:
  • Phone: 850-476-0559
  • Fax: 850-476-0599
Mailing address:
  • Phone: 850-476-0559
  • Fax: 850-476-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9102611
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: