Provider Demographics
NPI:1093089559
Name:GUSTAVSON, CHRISTINA URSO (APRN)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:URSO
Last Name:GUSTAVSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:ELIZABETH
Other - Last Name:URSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:2751 S DIXIE HWY STE 401
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-1233
Mailing Address - Country:US
Mailing Address - Phone:561-253-3980
Mailing Address - Fax:561-253-3985
Practice Address - Street 1:11382 PROSPERITY FARMS ROAD
Practice Address - Street 2:SUITE 228
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-253-3980
Practice Address - Fax:561-253-3985
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9436626363LF0000X
FLAPRN9436626163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily