Provider Demographics
NPI:1710588413
Name:CHACON CHACON, ARNOL MIGUEL (ARNP)
Entity Type:Individual
Prefix:
First Name:ARNOL
Middle Name:MIGUEL
Last Name:CHACON CHACON
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 RICH DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6508
Mailing Address - Country:US
Mailing Address - Phone:561-667-3141
Mailing Address - Fax:
Practice Address - Street 1:1001 RICH DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-6508
Practice Address - Country:US
Practice Address - Phone:561-667-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009618363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily