Provider Demographics
NPI:1295133353
Name:MORMAN, CHANI (ARNP)
Entity type:Individual
Prefix:
First Name:CHANI
Middle Name:
Last Name:MORMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 GAINESVILLE DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-6064
Mailing Address - Country:US
Mailing Address - Phone:321-663-2670
Mailing Address - Fax:386-769-3493
Practice Address - Street 1:1522 GAINESVILLE DR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-6064
Practice Address - Country:US
Practice Address - Phone:321-663-2670
Practice Address - Fax:386-769-3493
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9327484363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health