Provider Demographics
NPI:1841998580
Name:CHAMBERS, AMBER DIANE (APRN CNM)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DIANE
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:APRN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-868-8366
Mailing Address - Fax:
Practice Address - Street 1:50 FORTENBERRY RD
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3616
Practice Address - Country:US
Practice Address - Phone:321-868-8366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9452340163WM0102X, 163WX0003X
FLAPRN11024175363LX0001X, 367A00000X
FLCNM08343367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117548800Medicaid
FLQL820OtherMEDICARE HF