Provider Demographics
NPI:1821763475
Name:HARGROVE, CHELSEA NICHOLE (APRN)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:NICHOLE
Last Name:HARGROVE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13750 VISTA DEL LAGO BLVD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8044
Mailing Address - Country:US
Mailing Address - Phone:352-406-0023
Mailing Address - Fax:
Practice Address - Street 1:13750 VISTA DEL LAGO BLVD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8044
Practice Address - Country:US
Practice Address - Phone:352-406-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-14
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11014836363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health