Chacon, Wanda Ivette

Chacon, Wanda Ivette is an individual health care provider with primary practice located at 13933 17Th St Ste 200 , Dade City FL 33525-4604. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Chacon, Wanda Ivette can be contacted via phone (352) 437-5972.

Contact Information

Primary practice address
13933 17Th St Ste 200 Dade City FL 33525-4604
Phone: (352) 437-5972
Fax: (352) 437-5974
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X APRN2894372 Florida

Profile Details

NPI number 1407226194
LBN Legal business name Chacon, Wanda Ivette
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 7th, 2015
Last updated Feb 22nd, 2024 - about 9 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407226194 NPPES
Florida MEDICAID 021583900

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