Provider Demographics
NPI:1952692360
Name:CHISSELL, JUDY LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:LYNN
Last Name:CHISSELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 LUSTERLEAF PL
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4933
Mailing Address - Country:US
Mailing Address - Phone:727-639-5966
Mailing Address - Fax:
Practice Address - Street 1:1851 LUSTERLEAF PL
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4933
Practice Address - Country:US
Practice Address - Phone:727-639-5966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9311169163WC3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation