Provider Demographics
NPI:1477005874
Name:NAMMOUR, CHRISTINE ANN
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANN
Last Name:NAMMOUR
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 1:1219 E PARIS ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-6843
Mailing Address - Country:US
Mailing Address - Phone:813-505-3895
Mailing Address - Fax:
Practice Address - Street 1:1219 E PARIS ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-6843
Practice Address - Country:US
Practice Address - Phone:813-505-3895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-16-23688106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician