Provider Demographics
NPI:1629229604
Name:CHAPPEL, JORDAN MARK (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:MARK
Last Name:CHAPPEL
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:2711 N ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-1373
Mailing Address - Country:US
Mailing Address - Phone:844-362-2427
Mailing Address - Fax:877-293-7720
Practice Address - Street 1:2711 N ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1373
Practice Address - Country:US
Practice Address - Phone:844-362-2427
Practice Address - Fax:877-293-4823
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2015-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9104702363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical