Provider Demographics
NPI:1568131423
Name:DEMETRIUS, CHRISTINA (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:DEMETRIUS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15530 NE 15TH CT
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-5612
Mailing Address - Country:US
Mailing Address - Phone:305-495-9171
Mailing Address - Fax:
Practice Address - Street 1:15530 NE 15TH CT
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-5612
Practice Address - Country:US
Practice Address - Phone:305-495-9171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11014216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily