Provider Demographics
NPI:1609091438
Name:LANDECK, CHRISTINA MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:LANDECK
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 1:631 ALLENWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-1004
Mailing Address - Country:US
Mailing Address - Phone:352-259-4705
Mailing Address - Fax:
Practice Address - Street 1:631 ALLENWOOD LOOP
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-1004
Practice Address - Country:US
Practice Address - Phone:352-259-4705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1829532363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAG81OZOtherMEDICARE PTAN
FLARNP 1829532OtherARNP LICENSE NUMBER
2007000083-23OtherANCC GERI. BD. CERT.