Provider Demographics
NPI:1740995513
Name:AMAECHI, CHIOMA C (APRN)
Entity type:Individual
Prefix:
First Name:CHIOMA
Middle Name:C
Last Name:AMAECHI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4161 TAMIAMI TRL STE 701
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9283
Mailing Address - Country:US
Mailing Address - Phone:941-629-5356
Mailing Address - Fax:941-629-4987
Practice Address - Street 1:4130 TAMIAMI TRL UNIT 302
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9207
Practice Address - Country:US
Practice Address - Phone:941-629-5356
Practice Address - Fax:941-629-5878
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2023-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11021975363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner