Provider Demographics
NPI:1336484153
Name:CHANEY, ELIZABETH ERIN (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ERIN
Last Name:CHANEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:E
Other - Last Name:CHANEY-RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:13636 BLUEWATER CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8304
Mailing Address - Country:US
Mailing Address - Phone:502-396-9163
Mailing Address - Fax:
Practice Address - Street 1:5308 W IRLO BRONSON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-4754
Practice Address - Country:US
Practice Address - Phone:502-396-9163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007668363LF0000X
FL11005777363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily