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General NPI Number Information
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NPI Number | 1801489497
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Entity Type | Individual
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Provider Name | CHRISTOPHER DYLAN CHAMBLISS APRN
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Gender | Male
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Dates
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Enumeration Date | 02/16/2021
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 1667 N CLYDE MORRIS BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5500
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Country | US
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Telephone | 386-274-1414
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Fax |
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Provider Business Mailing Address
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Address Line | 1667 N CLYDE MORRIS BLVD STE 2
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5500
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Country | US
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Telephone | 386-274-4840
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Fax | 386-256-3008
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11011662
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN1101662
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License Number State | FL
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