Provider Demographics
NPI:1821341801
Name:OBEN, CHRISTELLE TAKOU (APRN)
Entity Type:Individual
Prefix:
First Name:CHRISTELLE
Middle Name:TAKOU
Last Name:OBEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 600865
Mailing Address - Street 2:4
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32260-4241
Mailing Address - Country:US
Mailing Address - Phone:904-217-8952
Mailing Address - Fax:682-201-2130
Practice Address - Street 1:3830 WILLIAMSBURG PARK BLVD UNIT 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-9200
Practice Address - Country:US
Practice Address - Phone:904-217-8952
Practice Address - Fax:682-201-2130
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1143754363LF0000X
FLAPRN11009471363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1821341801Medicaid