Provider Demographics
NPI:1346360492
Name:LINDSEY, CHIANTA SHAW (ARNP)
Entity type:Individual
Prefix:
First Name:CHIANTA
Middle Name:SHAW
Last Name:LINDSEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37912 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-4207
Mailing Address - Country:US
Mailing Address - Phone:352-518-2000
Mailing Address - Fax:407-447-7245
Practice Address - Street 1:232 N ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-1612
Practice Address - Country:US
Practice Address - Phone:407-428-5751
Practice Address - Fax:407-447-7245
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL384302363L00000X
FLARNP3084302363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305954500Medicaid
FLU1211YMedicare PIN