Provider Demographics
NPI:1124046222
Name:BOUCHARD, CHRISTINE HELENE (ARNP, PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:HELENE
Last Name:BOUCHARD
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Gender:F
Credentials:ARNP, PHD
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Mailing Address - Street 1:5406 HOOVER BLVD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5330
Mailing Address - Country:US
Mailing Address - Phone:813-248-8149
Mailing Address - Fax:813-884-7085
Practice Address - Street 1:5406 HOOVER BLVD
Practice Address - Street 2:SUITE 21
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5330
Practice Address - Country:US
Practice Address - Phone:813-248-8149
Practice Address - Fax:813-884-7085
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL2586882363LA2200X, 363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health