Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Chantal R Theodore

Individual provider Family Nurse Practitioner · NPI 1720630411

Chantal R Theodore is a Nurse Practitioner in Orlando, Florida. Qualified in 2018, 8 years ago. Practices with Orlando Health Medical Group Inc, a 2,137-clinician group and accepts Medicare assignment. Licensed in Florida and New Jersey.

Years since qualifying
8
Licensed in
FL, NJ
In the registry since
2019
Specialties on file
2
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Practice location Address checks out

1222 S Orange Avenue 4th Fl
Orlando, FL 32891-2027
Phone: (321) 841-6444
Fax: (407) 650-1307
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Adult Health Nurse Practitioner (primary) Taxonomy 363LA2200X · Licence APRN11016089 (FL)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 26NJ00883700 (NJ)

Record details

NPI number1720630411
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJuly 12, 2019
Last updated in NPPESAugust 4, 2022
Certification dateAugust 4, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Orlando Health Medical Group Inc — 2137 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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