Provider Demographics
NPI:1689004384
Name:CONOLOGUE, CHRISTA ASHLEY (ARNP-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:ASHLEY
Last Name:CONOLOGUE
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 E FLETCHER AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4656
Mailing Address - Country:US
Mailing Address - Phone:813-977-5557
Mailing Address - Fax:813-972-9211
Practice Address - Street 1:3000 E FLETCHER AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4656
Practice Address - Country:US
Practice Address - Phone:813-977-5557
Practice Address - Fax:813-972-9211
Is Sole Proprietor?:No
Enumeration Date:2013-11-15
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9293008363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHQ055XMedicare PIN
FLHQ055WMedicare PIN
FLHQ055YMedicare PIN