Provider Demographics
NPI:1437404019
Name:GILLIS, CRISTINA M (AP)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:M
Last Name:GILLIS
Suffix:
Gender:F
Credentials:AP
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Mailing Address - Street 1:1325 SAN MARCO BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8568
Mailing Address - Country:US
Mailing Address - Phone:904-858-7045
Mailing Address - Fax:904-858-7047
Practice Address - Street 1:14985 OLD SAINT AUGUSTINE RD
Practice Address - Street 2:STE 106
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-9477
Practice Address - Country:US
Practice Address - Phone:904-288-9491
Practice Address - Fax:904-288-9698
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLAP2964171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist