Provider Demographics
NPI:1801053020
Name:CHANDLER, MIRANDA J (PA)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:J
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2257 HIGHWAY 441 N
Mailing Address - Street 2:SUITE A
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-1943
Mailing Address - Country:US
Mailing Address - Phone:863-467-4788
Mailing Address - Fax:863-467-9092
Practice Address - Street 1:2257 HIGHWAY 441 N
Practice Address - Street 2:SUITE A
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1943
Practice Address - Country:US
Practice Address - Phone:863-467-4788
Practice Address - Fax:863-467-9092
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9104172363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9104172OtherSTATE LICENSE