MEDICARE: CHAIMA KUCK APRN

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	11040726	FL

General Provider Information

NPI Number	:	1598656506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAIMA KUCK APRN

Provider Business Mailing Address
First Line	:	225 S WOODLAND BLVD
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-5463
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 S WOODLAND BLVD
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-5463
Country	:	US
Telephone Number	:	386-943-3151
Fax Number	:

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

Provider Enumeration Date	:	07/09/2025
Last Update Date	:	11/06/2025

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Directions to “ CHAIMA KUCK APRN” Practice Location

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