Provider Demographics
NPI:1700329604
Name:ROSSIGNOL, CHILLINE
Entity Type:Individual
Prefix:
First Name:CHILLINE
Middle Name:
Last Name:ROSSIGNOL
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 1:124 WOODLAKE CIR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3082
Mailing Address - Country:US
Mailing Address - Phone:561-901-8038
Mailing Address - Fax:561-327-4002
Practice Address - Street 1:124 WOODLAKE CIR
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3082
Practice Address - Country:US
Practice Address - Phone:561-901-8038
Practice Address - Fax:561-327-4002
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5193444164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL164W00000XMedicaid