Provider Demographics
NPI:1609528421
Name:ADELPHONSE, CHRISTEPHANIE (LPN)
Entity Type:Individual
Prefix:
First Name:CHRISTEPHANIE
Middle Name:
Last Name:ADELPHONSE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 SW DAHLED AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-4027
Mailing Address - Country:US
Mailing Address - Phone:954-639-3834
Mailing Address - Fax:
Practice Address - Street 1:419 SW DAHLED AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-4027
Practice Address - Country:US
Practice Address - Phone:954-639-3834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-23
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5251560164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse