Individual
CHANTAL R THEODORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1222 S ORANGE AVENUE 4TH FL, ORLANDO, FL 32891-2027
(321) 841-6444
(407) 650-1307
Mailing address
1414 KUHL AVE # MP38, ORLANDO, FL 32806-2008
(321) 842-4713
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN11016089
FL
363LF0000X
Family Nurse Practitioner
26NJ00883700
NJ
Other
Enumeration date
07/12/2019
Last updated
08/04/2022
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