Provider Demographics
NPI:1568041481
Name:DEBARDELEBEN, CHANDLER MARDIS (RN)
Entity Type:Individual
Prefix:
First Name:CHANDLER
Middle Name:MARDIS
Last Name:DEBARDELEBEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1115
Mailing Address - Country:US
Mailing Address - Phone:321-214-4903
Mailing Address - Fax:321-841-2196
Practice Address - Street 1:62 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1115
Practice Address - Country:US
Practice Address - Phone:321-214-4903
Practice Address - Fax:321-841-2196
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9467216163WC0200X
FLAPRN11026371367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine