Individual provider Active NPI

Amber Ingram Chauncey, ARNP

  • Pediatric Nurse Practitioner
  • Live Oak, FL
National Provider Identifier
1043219645
Registry record updated Jun 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
ARNP3319392 Issued in FL
Practice address
1002 11TH St SW
Live Oak, FL 32064-3606
Phone
(386) 364-8050
NPI assigned
Jul 18, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X ARNP3319392 FL
Pediatric Nurse Practitioner 363LP0200X ARNP3319392 FL Primary

Addresses

Primary practice location

1002 11TH St SW
Live Oak, FL 32064-3606

Mailing address

10660 161St Rd
Live Oak, FL 32060-6280
Phone (386) 688-3865

Other practice location 1

1426 Canyon Ave NE
Live Oak, FL 32064
Phone (863) 208-0537

Other practice location 2

611 SE Demorest St
Live Oak, FL 32064
Phone (386) 362-5437

Other identifiers 1

IdentifierTypeStateIssuer
21213600MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
ARNP3319392FLMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Andres R Villar MD Past Accepting new patients
Andres R Villar MD Past Accepting new patients
Horizon Pediatrics, LLC Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654732800000",
    "number": "1043219645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10660 161ST RD",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "320606280",
            "telephone_number": "386-688-3865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 11TH ST SW",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "320643606",
            "telephone_number": "386-364-8050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1426 Canyon Ave NE",
            "address_purpose": "LOCATION",
            "city": "Live Oak",
            "state": "FL",
            "postal_code": "32064",
            "country_code": "US",
            "telephone_number": "863-208-0537",
            "fax_number": "386-330-0180",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "611 SE Demorest St",
            "address_purpose": "LOCATION",
            "city": "Live Oak",
            "state": "FL",
            "postal_code": "32064",
            "country_code": "US",
            "telephone_number": "386-362-5437",
            "fax_number": "386-362-5440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAUNCEY",
        "first_name": "AMBER",
        "middle_name": "INGRAM",
        "name_prefix": "Mrs.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-18",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP3319392",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "ARNP3319392",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21213600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Live Oak, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.