MEDICARE: ANGELA CHANDLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	9336943	FL

General Provider Information

NPI Number	:	1144722000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA CHANDLER

Provider Business Mailing Address
First Line	:	5900 TURKEY LAKE RD STE A
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-4216
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 TURKEY LAKE RD STE A
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-4216
Country	:	US
Telephone Number	:	407-351-9696
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2018
Last Update Date	:	03/22/2019

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Directions to “ ANGELA CHANDLER ” Practice Location

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