Provider Demographics
NPI:1235110669
Name:CHANCE, MARLENE C (APRN, MSN, PHD, EJD)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:C
Last Name:CHANCE
Suffix:
Gender:F
Credentials:APRN, MSN, PHD, EJD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 SW 57TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-7133
Mailing Address - Country:US
Mailing Address - Phone:954-581-8137
Mailing Address - Fax:
Practice Address - Street 1:2488 NORTH UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:954-983-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP0969002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2052ZMedicare PIN
FLS72616Medicare UPIN