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General NPI Number Information
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NPI Number | 1245609189
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Entity Type | Individual
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Provider Name | CHANDLER LARSEN YEAZITZIS PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 11/09/2015
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Provider Practice Location Address
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Address Line | 1 SHIRCLIFF WAY
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4748
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Country | US
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Telephone | 904-308-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 5700 SOUTHWYCK BLVD
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City | TOLEDO
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State | OH
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Zip | 43614-1509
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Country | US
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Telephone | 800-288-8325
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9109042
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9109042
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License Number State | FL
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