Healthcare Provider Details

I. General information

NPI: 1750996807
Provider Name (Legal Business Name): MRS. HEATHER NICOLE CHANDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 PINE ISLAND RD
ST AUGUSTINE FL
32095-8557
US

IV. Provider business mailing address

496 BLUEJACK LN
ST AUGUSTINE FL
32095-9032
US

V. Phone/Fax

Practice location:
  • Phone: 904-547-4300
  • Fax:
Mailing address:
  • Phone: 615-838-8843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ12030
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: