Provider Demographics
NPI:1346773900
Name:PREVILMA, CHRISTIANE
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIANE
Middle Name:
Last Name:PREVILMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14611 SOUTHERN BLVD UNIT 412
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-6819
Mailing Address - Country:US
Mailing Address - Phone:561-320-4053
Mailing Address - Fax:
Practice Address - Street 1:2006 CROSS BREEZE DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8075
Practice Address - Country:US
Practice Address - Phone:561-762-5414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X, 174N00000X
FLRN9499155163WP0200X
FLPN5216371405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No405300000XOther Service ProvidersPrevention Professional