Healthcare Provider Details

I. General information

NPI: 1699945923
Provider Name (Legal Business Name): RASHEETA D. CHANDLER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4202 E FOWLER AVE SHS 100
TAMPA FL
33620-6750
US

IV. Provider business mailing address

12901 BRUCE B DOWNS BLVD MDC 22
TAMPA FL
33612-4742
US

V. Phone/Fax

Practice location:
  • Phone: 813-974-2331
  • Fax: 813-974-5888
Mailing address:
  • Phone: 813-974-4244
  • Fax: 813-974-5418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9186139
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: