Provider Demographics
NPI:1336738657
Name:CAVANAUGH, CHRIS (RN)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:CAVANAUGH
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 1:3606 MOLONA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-5830
Mailing Address - Country:US
Mailing Address - Phone:321-230-7860
Mailing Address - Fax:
Practice Address - Street 1:3606 MOLONA DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-5830
Practice Address - Country:US
Practice Address - Phone:321-230-7860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2834722163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy