Provider Demographics
NPI:1619222981
Name:BOTTKOL, CHRISTINE A (ARNP-DNP)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:A
Last Name:BOTTKOL
Suffix:
Gender:F
Credentials:ARNP-DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4011
Mailing Address - Country:US
Mailing Address - Phone:850-763-4669
Mailing Address - Fax:850-769-6673
Practice Address - Street 1:510 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4011
Practice Address - Country:US
Practice Address - Phone:850-763-4669
Practice Address - Fax:850-769-6673
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9222669363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2012007553OtherANCC
FLF0512112OtherCERTIFICATION AANP F0512112