MEDICARE: EMMANUELLE CHASSAGNE NP

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	363L00000X	Nurse Practitioner	9211018	FL

General Provider Information

NPI Number	:	1841626470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMANUELLE CHASSAGNE NP

Provider Business Mailing Address
First Line	:	12656 SW 54TH ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-5478
Country	:	US
Telephone Number	:	954-770-7059
Fax Number	:

Provider Business Practice Location Address
First Line	:	11948 WASHINGTON ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33025-5752
Country	:	US
Telephone Number	:	954-770-7059
Fax Number	:

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

Provider Enumeration Date	:	09/13/2013
Last Update Date	:	09/13/2013

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