=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003136474
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW CHASE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2010
-----------------------------------------------------
Last Update Date | 11/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 505 BAY ISLES PKWY
-----------------------------------------------------
City | LONGBOAT KEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34228-3133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-383-2475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 505 BAY ISLES PKWY
-----------------------------------------------------
City | LONGBOAT KEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN9283466
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------