Provider Demographics
NPI:1891768578
Name:CHRISTENSEN, CONNIE CHRISTINE (CRNA ARNP)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:CHRISTINE
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:CRNA ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 SW 8TH TER
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-1262
Mailing Address - Country:US
Mailing Address - Phone:954-463-5057
Mailing Address - Fax:954-760-9887
Practice Address - Street 1:1613 HARRISON PKWY
Practice Address - Street 2:#200
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2853
Practice Address - Country:US
Practice Address - Phone:954-838-2371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP804702367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34088000Medicaid
FLG0724ZMedicare ID - Type Unspecified
FLG0724YMedicare ID - Type Unspecified