Provider Demographics
NPI:1407549892
Name:HUNT, CHANEL MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:CHANEL
Middle Name:MARIE
Last Name:HUNT
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-1600
Mailing Address - Fax:239-424-1640
Practice Address - Street 1:1682 NE PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-1756
Practice Address - Country:US
Practice Address - Phone:239-424-1640
Practice Address - Fax:239-424-1640
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11025982363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118761900Medicaid