Provider Demographics
NPI:1437267747
Name:CANCHOLA, DENISE ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:ANN
Last Name:CANCHOLA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:DENISE
Other - Middle Name:CANCHOLA
Other - Last Name:DE TOURNILLON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:600 SW 3RD ST
Mailing Address - Street 2:SUITE 2270
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-6932
Mailing Address - Country:US
Mailing Address - Phone:954-960-8900
Mailing Address - Fax:954-960-8888
Practice Address - Street 1:600 SW 3RD ST
Practice Address - Street 2:SUITE 2270
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6932
Practice Address - Country:US
Practice Address - Phone:954-960-8900
Practice Address - Fax:954-960-8888
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1348922363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY5697Medicare ID - Type Unspecified
FLS57487Medicare UPIN