Provider Demographics
NPI:1255074183
Name:CHAMBERS, AMBER JAQUISE
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:JAQUISE
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N KIMBREL AVE LOT 90
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-9555
Mailing Address - Country:US
Mailing Address - Phone:850-338-4475
Mailing Address - Fax:
Practice Address - Street 1:420 N KIMBREL AVE LOT 90
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-9555
Practice Address - Country:US
Practice Address - Phone:850-338-4475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide