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1063413748 NPI number — NICOLE MARIE CHONG PA

NPI Number: 1063413748
Health Care Provider/Practitioner: NICOLE MARIE CHONG PA

Information about “1063413748” NPI (NICOLE MARIE CHONG PA) exists in 1063413748 in HTML format HTML  |  1063413748 in plain Text format TXT  |  1063413748 in PDF (Portable Document Format) PDF  |  1063413748 in an XML format XML  formats.

NPI Number : 1063413748 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063413748",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CHONG",
    "FirstName": "NICOLE",
    "MiddleName": "MARIE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "PA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "11249 BRANDYWINE LAKE WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BOYNTON BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33473-4891",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "561-926-3328",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1613 NW 136TH AVE",
    "SecondLinePracticeLocationAddress": "SUITE 200",
    "PracticeLocationAddressCityName": "SUNRISE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33323-2853",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "800-437-2672",
    "PracticeLocationAddressFaxNumber": "281-851-1416",
    "EnumerationDate": "08/03/2005",
    "LastUpdateDate": "09/06/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "PA03403",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "PA9101662",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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