Provider Demographics
NPI:1225244007
Name:JOHNSON HACKSHAW, CHRISTINE (ARNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:JOHNSON HACKSHAW
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 GLADES RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6421
Mailing Address - Country:US
Mailing Address - Phone:561-430-3933
Mailing Address - Fax:561-430-3943
Practice Address - Street 1:900 GLADES RD
Practice Address - Street 2:SUITE 4
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6421
Practice Address - Country:US
Practice Address - Phone:561-430-3933
Practice Address - Fax:561-430-3943
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2572382363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner