Provider Demographics
NPI:1568962165
Name:KOM, CHRISTIANE DANIELE (ARNP)
Entity Type:Individual
Prefix:
First Name:CHRISTIANE
Middle Name:DANIELE
Last Name:KOM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 SKYRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5111
Mailing Address - Country:US
Mailing Address - Phone:407-267-5099
Mailing Address - Fax:
Practice Address - Street 1:843 SKYRIDGE RD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5111
Practice Address - Country:US
Practice Address - Phone:407-267-5099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9272980363L00000X
FL9271980363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner