Provider Demographics
NPI:1003670639
Name:CHAOS, NICOLAS (FNP)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:CHAOS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14606 SW 38TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7852
Mailing Address - Country:US
Mailing Address - Phone:786-499-2703
Mailing Address - Fax:
Practice Address - Street 1:14606 SW 38TH ST APT 6
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-7852
Practice Address - Country:US
Practice Address - Phone:786-499-2703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF02240494363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty