Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | APRN9283466 | FL |
NPI | 1003136474 |
---|---|
Provider Name | Andrew Chase |
First Address | Longboat Key, FL 34228 |
Second Address | Longboat Key, FL 34228-3133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2010 |
Last Update Date | 19/11/2018 |