Healthcare Provider Details

I. General information

NPI: 1073024089
Provider Name (Legal Business Name): CHANEL DIOR COCHRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18951 N MEMORIAL DR
HUMBLE TX
77338-4217
US

IV. Provider business mailing address

7751 BELFORT PKWY STE 120
JACKSONVILLE FL
32256-6921
US

V. Phone/Fax

Practice location:
  • Phone: 904-372-3943
  • Fax:
Mailing address:
  • Phone: 904-372-3943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP135531
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: