Provider Demographics
NPI:1750115010
Name:CHAUDHARI, VINITABEN BALDEVBHAI (FNP-C)
Entity type:Individual
Prefix:
First Name:VINITABEN
Middle Name:BALDEVBHAI
Last Name:CHAUDHARI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 VIXEN CT
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-9353
Mailing Address - Country:US
Mailing Address - Phone:850-272-9052
Mailing Address - Fax:
Practice Address - Street 1:3813 ROSS CLARK CIR STE 300
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-2881
Practice Address - Country:US
Practice Address - Phone:334-479-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11034972363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily