Provider Demographics
NPI:1205888559
Name:BROWN, CHRISTINA JOY (PA)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JOY
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 CLEVELAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7182
Mailing Address - Country:US
Mailing Address - Phone:239-936-6778
Mailing Address - Fax:239-277-3273
Practice Address - Street 1:3210 CLEVELAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7182
Practice Address - Country:US
Practice Address - Phone:239-936-6778
Practice Address - Fax:239-277-3273
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100877363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0664623OtherAETNA PPO
FL065642900Medicaid
FL592207264EOtherHUMANA
FL0905258OtherUHC
FL592207264OtherCIGNA PPO
FL0599681OtherGHI PPO
FL36291OtherBCBS
FL4130734OtherAETNA HMO
FL1716925002OtherCIGNA HMO
FLE1994ZMedicare PIN
FL0664623OtherAETNA PPO
FL970010133Medicare PIN
FL1716925002OtherCIGNA HMO
FLS71459Medicare UPIN