Provider Demographics
NPI:1598446965
Name:ASHBURN, CRISTA MARIE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CRISTA
Middle Name:MARIE
Last Name:ASHBURN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2544 SW ABELARD ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-7333
Mailing Address - Country:US
Mailing Address - Phone:772-708-8793
Mailing Address - Fax:
Practice Address - Street 1:2544 SW ABELARD ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-7333
Practice Address - Country:US
Practice Address - Phone:772-708-8793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11027639363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily