Provider Demographics
NPI:1134559479
Name:PARKS, CHRISTINA RUTH (CRNA)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:RUTH
Last Name:PARKS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:RUTH
Other - Last Name:VANCUREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1613 HARRISON PKWY
Mailing Address - Street 2:SUITE 200, MAILSTOP SH-9A
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2896
Mailing Address - Country:US
Mailing Address - Phone:954-514-4793
Mailing Address - Fax:954-514-3915
Practice Address - Street 1:2280 OPITZ BLVD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191
Practice Address - Country:US
Practice Address - Phone:703-670-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-23
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0024171404367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program