Provider Demographics
NPI:1982865283
Name:CONNER, CHRISTINA ANDERSON (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANDERSON
Last Name:CONNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHRISTINA
Other - Middle Name:KAY
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84110-0959
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:520 A1A N
Practice Address - Street 2:SUITE 102
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-5212
Practice Address - Country:US
Practice Address - Phone:904-280-1225
Practice Address - Fax:904-285-4522
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201100870208000000X
FLME118737208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC201100870OtherLICENSE
FLME118737OtherFLORIDA MEDICAL LICENSE