Provider Demographics
NPI:1144376088
Name:CHAPMAN, CARRIE M (PA-C)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:M
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3300 S. FISKE BLVD.
Mailing Address - Street 2:CREDENTIALING
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-9230
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:1223 GATEWAY DR STE 2A
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2607
Practice Address - Country:US
Practice Address - Phone:321-434-9230
Practice Address - Fax:321-434-8229
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117323200Medicaid
FLAC979WOtherMEDICARE
FLQ79547Medicare UPIN
FLAC979ZMedicare PIN