Provider Demographics
NPI:1174378061
Name:MEJIAS CHACON, EDGARDO (APRN)
Entity type:Individual
Prefix:
First Name:EDGARDO
Middle Name:
Last Name:MEJIAS CHACON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13926 HENSON CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-3121
Mailing Address - Country:US
Mailing Address - Phone:813-240-8377
Mailing Address - Fax:
Practice Address - Street 1:13926 HENSON CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-3121
Practice Address - Country:US
Practice Address - Phone:813-240-8377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11032256363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily