Provider Demographics
NPI:1952171415
Name:CHASE, RITA LAUREN (CD, CPD, CLC)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:LAUREN
Last Name:CHASE
Suffix:
Gender:F
Credentials:CD, CPD, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 HAMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:FL
Mailing Address - Zip Code:33920-4681
Mailing Address - Country:US
Mailing Address - Phone:239-770-0034
Mailing Address - Fax:
Practice Address - Street 1:3406 HAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:FL
Practice Address - Zip Code:33920-4681
Practice Address - Country:US
Practice Address - Phone:239-770-0034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174N00000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN