Provider Demographics
NPI:1407535479
Name:HOBBS, CHANAE OCTAVIA (RN)
Entity Type:Individual
Prefix:
First Name:CHANAE
Middle Name:OCTAVIA
Last Name:HOBBS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EAST ST
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-8584
Mailing Address - Country:US
Mailing Address - Phone:386-546-9307
Mailing Address - Fax:
Practice Address - Street 1:13418 GLACIER NATIONAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-4356
Practice Address - Country:US
Practice Address - Phone:386-546-9307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9422205163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty