MEDICARE: MR. JEAN CHONOLES P.A.

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	363A00000X	Physician Assistant	FL2209	FL

General Provider Information

NPI Number	:	1720293129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEAN CHONOLES P.A.

Provider Business Mailing Address
First Line	:	3920 6TH AVE NE
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34120-9010
Country	:	US
Telephone Number	:	239-353-9735
Fax Number	:

Provider Business Practice Location Address
First Line	:	4867 GOLDEN GATE PKWY
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34116-6953
Country	:	US
Telephone Number	:	239-234-5623
Fax Number	:	239-234-5624

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

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	02/24/2014

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