Provider Demographics
NPI:1619993227
Name:CRAIG, CHRISTINE D (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:D
Last Name:CRAIG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:DEROY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10051 5TH STREET NORTH #200
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33715-1565
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:727-867-6835
Practice Address - Street 1:5101 BRITTANY DR S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33715-1565
Practice Address - Country:US
Practice Address - Phone:727-867-2151
Practice Address - Fax:727-867-6835
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1380412363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP45871Medicare UPIN
FLE6594VMedicare PIN