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General NPI Number Information
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NPI Number | 1932883477
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Entity Type | Individual
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Provider Name | CHASE SIMPSON
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Gender | Male
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Dates
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Enumeration Date | 06/14/2023
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 250 PALM COAST PKWY NE UNIT 1302
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City | PALM COAST
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State | FL
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Zip | 32137-8289
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Country | US
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Telephone | 239-784-5087
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Fax |
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Provider Business Mailing Address
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Address Line | 250 PALM COAST PKWY NE UNIT 1302
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City | PALM COAST
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State | FL
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Zip | 32137-8289
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Country | US
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 28255
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License Number State | FL
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