Provider Demographics
NPI:1730120452
Name:NIELSON, CHRISTINE PATRICE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:PATRICE
Last Name:NIELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 36TH ST STE H
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4898
Mailing Address - Country:US
Mailing Address - Phone:772-564-8383
Mailing Address - Fax:772-564-8377
Practice Address - Street 1:1300 36TH ST STE H
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4898
Practice Address - Country:US
Practice Address - Phone:772-564-8383
Practice Address - Fax:772-564-8377
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91976207QG0300X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273385400Medicaid
FLH95494Medicare UPIN