Provider Demographics
NPI:1275820102
Name:FELICIANO, CHRISTINA HELENA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:HELENA
Last Name:FELICIANO
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 1:15086 BULOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-1179
Mailing Address - Country:US
Mailing Address - Phone:904-233-2474
Mailing Address - Fax:
Practice Address - Street 1:1200 RIVERSIDEPLSCE
Practice Address - Street 2:620
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207
Practice Address - Country:US
Practice Address - Phone:904-396-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9270245363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003803300Medicaid
GA003160738AMedicaid
FL003803300Medicaid
GA003160738AMedicaid
FLFD353WMedicare PIN