Provider Demographics
NPI:1205460367
Name:CHINHEYA, PHOMELLO P (APRN)
Entity type:Individual
Prefix:MS
First Name:PHOMELLO
Middle Name:P
Last Name:CHINHEYA
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 1:530 RONSHELLE AVE
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-6399
Mailing Address - Country:US
Mailing Address - Phone:407-234-3434
Mailing Address - Fax:
Practice Address - Street 1:1205 DR MARTIN L KING JR WAY
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-3490
Practice Address - Country:US
Practice Address - Phone:863-353-6853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005583363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care