Provider Demographics
NPI:1902573256
Name:TOLER BUCKLEY, CHELSIE CHENILLE (PMHNP, APRN)
Entity Type:Individual
Prefix:
First Name:CHELSIE
Middle Name:CHENILLE
Last Name:TOLER BUCKLEY
Suffix:
Gender:F
Credentials:PMHNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12716 BLACK ANGUS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-5837
Mailing Address - Country:US
Mailing Address - Phone:904-554-1835
Mailing Address - Fax:
Practice Address - Street 1:103 CENTURY 21 DR STE 213
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-9295
Practice Address - Country:US
Practice Address - Phone:904-475-2039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11014972363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11014972Medicaid
FL9307397OtherBOARD OF NURSING