Provider Demographics
NPI:1073968715
Name:ROSBOROUGH, CRISTA MARINA ANA LUCIA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:CRISTA
Middle Name:MARINA ANA LUCIA
Last Name:ROSBOROUGH
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 SW 62ND BLVD APT 90
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2078
Mailing Address - Country:US
Mailing Address - Phone:412-477-9382
Mailing Address - Fax:
Practice Address - Street 1:21403 SE 70TH AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:FL
Practice Address - Zip Code:32640
Practice Address - Country:US
Practice Address - Phone:412-477-9382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL4275174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL4275OtherDEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE