Individual
CHANEL ST MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2385 N LECANTO HWY, LECANTO, FL 34461-9677
(352) 527-6888
Mailing address
1990 N PROSPECT AVE, LECANTO, FL 34461-9792
(352) 527-6888
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
000758-PA
PR
363A00000X
Physician Assistant
8551
AZ
363A00000X
Physician Assistant
Primary
PACN1
FL
363A00000X
Physician Assistant
TPPA184
FL
Other
Enumeration date
08/29/2020
Last updated
03/12/2025
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