Basic Information
| Provider Information | |||||||||
| NPI: | 1245995919 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUSTESEN | ||||||||
| FirstName: | CHLOE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4855 MEADOW DR | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347727581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3212177600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 92 W MILLER ST | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328062032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218415104 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2021 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN9442481 | FL | Y | Nursing Service Providers | Registered Nurse |
No ID Information.