Provider Demographics
NPI:1417952847
Name:CHRISTEN, IVORY JOE (ARNP)
Entity Type:Individual
Prefix:
First Name:IVORY
Middle Name:JOE
Last Name:CHRISTEN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5524
Mailing Address - Country:US
Mailing Address - Phone:954-455-3301
Mailing Address - Fax:954-455-4435
Practice Address - Street 1:201 E HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5524
Practice Address - Country:US
Practice Address - Phone:954-455-3301
Practice Address - Fax:954-455-4435
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1714142363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301753200Medicaid
FLY7120Medicare ID - Type Unspecified
FL301753200Medicaid
Y7120FMedicare PIN
FLS51923Medicare UPIN