Provider Demographics
NPI:1407834864
Name:BROCKMAN, CHRISTINA (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BROCKMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 US HIGHWAY 98 W STE 350
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-9200
Mailing Address - Country:US
Mailing Address - Phone:850-622-3393
Mailing Address - Fax:850-622-3371
Practice Address - Street 1:7720 US HIGHWAY 98 W STE 350
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-9200
Practice Address - Country:US
Practice Address - Phone:850-622-3393
Practice Address - Fax:850-622-3371
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16493207Q00000X
IN02005288A207Q00000X
KY03514207Q00000X
OH34-008157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3041587Medicaid
KYP01296768OtherRR MEDICARE
KY7100121880Medicaid
KYP01296768OtherRR MEDICARE
I25583Medicare UPIN