Provider Demographics
NPI:1023047446
Name:CHANEY, JAMES C (ARNP)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:CHANEY
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:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:GONZALEZ
Mailing Address - State:FL
Mailing Address - Zip Code:32560-0244
Mailing Address - Country:US
Mailing Address - Phone:850-623-2948
Mailing Address - Fax:850-626-2734
Practice Address - Street 1:2 SUGARBOWL LANE
Practice Address - Street 2:
Practice Address - City:PENSACOLA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32561
Practice Address - Country:US
Practice Address - Phone:850-418-2128
Practice Address - Fax:850-916-0788
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2210632363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302818600Medicaid
P00297615OtherRAILROAD MEDICARE
FL17449OtherBLUE CROSS BLUE SHIELD
AL591-69733OtherBLUE CROSS BLUE SHIELD
S75876Medicare UPIN
AL591-69733OtherBLUE CROSS BLUE SHIELD