Provider Demographics
NPI:1457758435
Name:CHAMBERLAIN, ALEX
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 PONCE DE LEON BLVD STE 701
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-1031
Mailing Address - Country:US
Mailing Address - Phone:727-447-5845
Mailing Address - Fax:
Practice Address - Street 1:1180 PONCE DE LEON BLVD STE 701
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-1031
Practice Address - Country:US
Practice Address - Phone:727-447-5845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992282376K00000X, 372600000X, 374U00000X, 376J00000X
FL29992282372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299992282OtherHOME HEALTH AGENCY LICENSE