Provider Demographics
NPI:1760016604
Name:CHACE, JANET L (PHLEBOTOMIST)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:CHACE
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:LYNNE
Other - Last Name:CHACE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 290474
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-0474
Mailing Address - Country:US
Mailing Address - Phone:386-872-2581
Mailing Address - Fax:
Practice Address - Street 1:6047 BURGUNDY TER
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-6785
Practice Address - Country:US
Practice Address - Phone:386-872-2581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-01
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246QH0000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHematologyGroup - Single Specialty