Provider Demographics
NPI:1720365448
Name:BOURGOIN, CHRISTINE CAROLINE (FNP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:CAROLINE
Last Name:BOURGOIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6006 49TH ST N STE 120
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2149
Mailing Address - Country:US
Mailing Address - Phone:727-528-5739
Mailing Address - Fax:727-528-5855
Practice Address - Street 1:6006 49TH ST N STE 120
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2149
Practice Address - Country:US
Practice Address - Phone:727-528-5739
Practice Address - Fax:727-528-5855
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001180899163WM0705X
FL9166500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical