Provider Demographics
NPI:1366109522
Name:BRITTAIN, CHAKA GROVER (ARNP)
Entity type:Individual
Prefix:
First Name:CHAKA
Middle Name:GROVER
Last Name:BRITTAIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CHAKA
Other - Middle Name:GROVER
Other - Last Name:BRITTAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:172 OXBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-7083
Mailing Address - Country:US
Mailing Address - Phone:850-524-3744
Mailing Address - Fax:
Practice Address - Street 1:800 SHETTER AVE FL 32250
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-4348
Practice Address - Country:US
Practice Address - Phone:904-241-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11016737363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner