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General NPI Number Information
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NPI Number | 1164153979
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Entity Type | Individual
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Provider Name | TINA CHANDLER FNP
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Gender | Female
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Dates
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Enumeration Date | 06/22/2022
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 125 EARL CLARK DR
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City | FLORENCE
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State | MS
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Zip | 39073-6605
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Country | US
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Telephone | 601-891-8657
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Fax | 949-561-5551
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Provider Business Mailing Address
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Address Line | 125 EARL CLARK DR
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City | FLORENCE
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State | MS
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Zip | 39073-6605
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Country | US
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Telephone | 601-891-8657
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Fax | 949-561-5551
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 905384
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License Number State | MS
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