Provider Demographics
NPI:1164019618
Name:CHAMBERLAND, JUSTIN (APRN)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:CHAMBERLAND
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 1:981 E EAU GALLIE BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4928
Mailing Address - Country:US
Mailing Address - Phone:321-344-3267
Mailing Address - Fax:
Practice Address - Street 1:981 E EAU GALLIE BLVD STE E
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4928
Practice Address - Country:US
Practice Address - Phone:321-344-3267
Practice Address - Fax:321-406-7697
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11010799207QH0002X
FL11010799363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111332800Medicaid