Provider Demographics
NPI:1376016048
Name:LUNDSTEDT, CHRISTINE SUZANNE (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:SUZANNE
Last Name:LUNDSTEDT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S PARK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8541
Mailing Address - Country:US
Mailing Address - Phone:866-986-2263
Mailing Address - Fax:
Practice Address - Street 1:5395 RUFFIN RD STE 204
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1338
Practice Address - Country:US
Practice Address - Phone:858-571-3630
Practice Address - Fax:858-430-3146
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-06
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009138363LF0000X
FL11009616363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily