Provider Demographics
NPI:1477044733
Name:ORANGE, CHRISTOPHER BRIAN (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:BRIAN
Last Name:ORANGE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13620 LAS BRISAS WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-3082
Mailing Address - Country:US
Mailing Address - Phone:407-488-4125
Mailing Address - Fax:
Practice Address - Street 1:13620 LAS BRISAS WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-3082
Practice Address - Country:US
Practice Address - Phone:407-488-4125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9111282363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant