Provider Demographics
NPI:1194201392
Name:CHISHIMBA, MCEBA WESTON (APRN-C)
Entity Type:Individual
Prefix:MR
First Name:MCEBA
Middle Name:WESTON
Last Name:CHISHIMBA
Suffix:
Gender:M
Credentials:APRN-C
Other - Prefix:MR
Other - First Name:WESTON
Other - Middle Name:MGEBA
Other - Last Name:CHISHIMBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN-C
Mailing Address - Street 1:2350 SUNSET POINT RD STE C
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1443
Mailing Address - Country:US
Mailing Address - Phone:727-797-3155
Mailing Address - Fax:727-797-4301
Practice Address - Street 1:2350 SUNSET POINT RD STE C
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1443
Practice Address - Country:US
Practice Address - Phone:727-797-3155
Practice Address - Fax:727-797-4301
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9318321363LF0000X
FLAPRN9318321363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101591300Medicaid