Provider Demographics
NPI:1093797458
Name:SHORT, CHRISTINA F (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:F
Last Name:SHORT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 W SAN JOSE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7155
Mailing Address - Country:US
Mailing Address - Phone:813-835-6465
Mailing Address - Fax:
Practice Address - Street 1:3301 W SAN JOSE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-7155
Practice Address - Country:US
Practice Address - Phone:813-835-6465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74250207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
050079713OtherRAILROAD MEDICARE
FL254740600Medicaid
FL42851OtherBCBS
G79955Medicare UPIN
FL254740600Medicaid