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General NPI Number Information
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NPI Number | 1770835167
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Entity Type | Individual
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Provider Name | CHLOE JACENDA BOSTIC RN
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Gender | Female
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Dates
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Enumeration Date | 10/09/2012
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Last Update Date | 05/05/2016
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Provider Practice Location Address
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Address Line | 3 COBLENTZ GARDENS
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City | PORT OF SPAIN
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State | ARIMA
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Zip | 33029
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Country | TT
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Telephone | 18686210063
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Fax |
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Provider Business Mailing Address
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Address Line | LADY YOUNG ROAD
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City | PORT OF SPAIN
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State | TRINIDAD
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Zip | 55469
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Country | TT
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN6545464
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License Number State | PA
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