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General NPI Number Information
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NPI Number | 1508638057
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Entity Type | Individual
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Provider Name | CHANAE COTTRELL-PRATT
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Gender | Female
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Dates
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Enumeration Date | 10/27/2023
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 10080 SW INNOVATION WAY
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City | PORT ST LUCIE
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State | FL
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Zip | 34987-2127
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Country | US
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Telephone | 772-344-3811
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Fax | 772-344-3890
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Provider Business Mailing Address
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Address Line | 10014 WHITE BLUFF RD APT 1503
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City | SAVANNAH
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State | GA
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Zip | 31406-5605
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Country | US
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Telephone | 801-616-8236
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9117794
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9117794
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License Number State | FL
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