Provider Demographics
NPI:1225431166
Name:RHODEN, CHAD
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:
Last Name:RHODEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SW ARCHER RD
Mailing Address - Street 2:ROOM NUMBER 2944
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-3003
Mailing Address - Country:US
Mailing Address - Phone:352-265-8940
Mailing Address - Fax:352-265-8970
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:ROOM NUMBER 2944
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-8940
Practice Address - Fax:352-265-8970
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9249227363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013565200Medicaid
FLHZ302ZMedicare PIN