Provider Demographics
NPI:1811484298
Name:CULLEY, CHANEL BLANCHARD (MSN, CNM, APRN)
Entity type:Individual
Prefix:MRS
First Name:CHANEL
Middle Name:BLANCHARD
Last Name:CULLEY
Suffix:
Gender:F
Credentials:MSN, CNM, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 W MILLER ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2031
Mailing Address - Country:US
Mailing Address - Phone:321-841-5281
Mailing Address - Fax:407-648-9879
Practice Address - Street 1:83 W MILLER ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2031
Practice Address - Country:US
Practice Address - Phone:321-841-5281
Practice Address - Fax:407-648-9879
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9368700363LX0001X
FLAPRN9368700367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101609900Medicaid