Healthcare Provider Details

I. General information

NPI: 1083128573
Provider Name (Legal Business Name): CHLOE JEAN SOLIS MD, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHLOE ALICE JEAN MD

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12780 RACE TRACK RD STE 400
TAMPA FL
33626-1395
US

IV. Provider business mailing address

1881 SE TIFFANY AVE STE 102
PORT ST LUCIE FL
34952-7567
US

V. Phone/Fax

Practice location:
  • Phone: 813-321-6262
  • Fax: 813-443-8150
Mailing address:
  • Phone: 772-398-7936
  • Fax: 772-398-7970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW14823
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME175814
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN36735
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: