Provider Demographics
NPI:1750860367
Name:RICE, CHRISTAL LOUISE (FNP)
Entity Type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:LOUISE
Last Name:RICE
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 1:397 SW BELMONT CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-7103
Mailing Address - Country:US
Mailing Address - Phone:279-718-8835
Mailing Address - Fax:772-673-8440
Practice Address - Street 1:4550 S JOG RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-4160
Practice Address - Country:US
Practice Address - Phone:561-332-1762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704263161363LF0000X
FLAPRN11016039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000000OtherNONE