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General NPI Number Information
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NPI Number | 1750599833
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Entity Type | Individual
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Provider Name | CHADD KAWIKA EAGLIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/20/2007
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Last Update Date | 02/19/2021
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Provider Practice Location Address
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Address Line | 1579 THE GREENS WAY STE 18
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-1418
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Country | US
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Telephone | 904-373-0659
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Fax |
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Provider Business Mailing Address
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Address Line | 1579 THE GREENS WAY STE 18
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-1418
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Country | US
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Telephone | 904-373-0659
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MDR-5073
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME126425
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License Number State | FL
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