Provider Demographics
NPI:1275622631
Name:CHASTAIN, MICHELE V (APRN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:V
Last Name:CHASTAIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 7TH ST N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5754
Mailing Address - Country:US
Mailing Address - Phone:239-624-4200
Mailing Address - Fax:239-624-4201
Practice Address - Street 1:350 7TH ST N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5754
Practice Address - Country:US
Practice Address - Phone:239-624-4200
Practice Address - Fax:239-624-4201
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9481595363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJK488ZOtherMEDICARE
FL024300400Medicaid
FLO9BMMOtherBCBS