Provider Demographics
NPI:1699945923
Name:CHANDLER, RASHEETA D (ARNP)
Entity type:Individual
Prefix:
First Name:RASHEETA
Middle Name:D
Last Name:CHANDLER
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 1:12901 BRUCE B DOWNS BLVD
Mailing Address - Street 2:MDC 22
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4742
Mailing Address - Country:US
Mailing Address - Phone:813-974-4244
Mailing Address - Fax:813-974-5418
Practice Address - Street 1:4202 E FOWLER AVE
Practice Address - Street 2:SHS 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33620-6750
Practice Address - Country:US
Practice Address - Phone:813-974-2331
Practice Address - Fax:813-974-5888
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9186139363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY09YUOtherBLUE CROSS BLUE SHIELD
FL004637700Medicaid
FLAJ552YMedicare PIN