Provider Demographics
NPI:1417923822
Name:CHAMBERS, WENDY L (PA-C)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:L
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4203 BELFORT RD STE 108
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1411
Mailing Address - Country:US
Mailing Address - Phone:904-450-6460
Mailing Address - Fax:904-450-6469
Practice Address - Street 1:4203 BELFORT RD STE 108
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1411
Practice Address - Country:US
Practice Address - Phone:904-450-6460
Practice Address - Fax:904-450-6469
Is Sole Proprietor?:No
Enumeration Date:2006-02-25
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3225363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA135550005AMedicaid
FL2907160-00Medicaid
FLS54476Medicare UPIN
FL970016795Medicare PIN
FL2907160-00Medicaid
FLE0624Medicare PIN