Provider Demographics
NPI:1073683553
Name:CHAPTERS HEALTH PALLIATIVE CARE, LLC
Entity Type:Organization
Organization Name:CHAPTERS HEALTH PALLIATIVE CARE, LLC
Other - Org Name:AXIS PALLIATIVE HEALTHCARE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:STAFF ATTORNEY
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCCIARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-871-8075
Mailing Address - Street 1:12470 TELECOM DR
Mailing Address - Street 2:SUITE 300 - ATTENTION: COMPLIANCE
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0904
Mailing Address - Country:US
Mailing Address - Phone:813-871-8200
Mailing Address - Fax:813-871-8199
Practice Address - Street 1:12470 TELECOM DR
Practice Address - Street 2:SUITE 300
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-0904
Practice Address - Country:US
Practice Address - Phone:813-871-8200
Practice Address - Fax:813-871-8199
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHAPTERS HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-09
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1437336302OtherPROVIDER - ZOE LEWIS MD
1134156813OtherPROVIDER - ANDREA MILLER MD
1376071415OtherPROVIDER - KERINE HINDS APRN
1538669627OtherPROVIDER - RATCHADAKON TRAN APRN
1609115534OtherPROVIDER - MATTHEW PETTIT APRN
1902134208OtherPROVIDER - ISABEL BALES APRN
1083928592OtherPROVIDER - RAVI SAMLAL DO
1144679176OtherPROVIDER - MARIBETH ALLEN APRN
1275872459OtherPROVIDER - JESSICA NOVAK APRN
1548294655OtherPROVIDER - MARY ALFONO TORRES MD
1194037770OtherPROVIDER - ANTHONY JONES MD
1255758389OtherPROVIDER - JULIE MARTINEZ APRN
1720276157OtherPROVIDER - TERA GEARHART APRN
1669622858OtherPROVIDER - KATHLEEN CURRAN APRN
1710428602OtherPROVIDER - JESSICA BAILES APRN
1003360058OtherPROVIDER - FITZWILLIAM MUSOKO ESELE APRN