Provider Demographics
NPI:1841626470
Name:CHASSAGNE, EMMANUELLE (NP)
Entity type:Individual
Prefix:
First Name:EMMANUELLE
Middle Name:
Last Name:CHASSAGNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:EMMANUELLE
Other - Middle Name:
Other - Last Name:CHASSAGNE- GASTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12656 SW 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5478
Mailing Address - Country:US
Mailing Address - Phone:954-770-7059
Mailing Address - Fax:
Practice Address - Street 1:11948 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-5752
Practice Address - Country:US
Practice Address - Phone:954-770-7059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9211018363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner