Provider Demographics
NPI:1922318641
Name:MATHIS, CHELSEA MARIANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:MARIANNE
Last Name:MATHIS
Suffix:
Gender:F
Credentials:PA-C
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 S LAKE ST STE 9
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7369
Mailing Address - Country:US
Mailing Address - Phone:352-435-7695
Mailing Address - Fax:
Practice Address - Street 1:700 E MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4624
Practice Address - Country:US
Practice Address - Phone:407-481-2620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2020-06-18
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant