Provider Demographics
NPI:1295944650
Name:CHRISTIANA, JOANNE (OD)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:
Last Name:CHRISTIANA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10884 NW 17TH MNR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6318
Mailing Address - Country:US
Mailing Address - Phone:954-755-5415
Mailing Address - Fax:
Practice Address - Street 1:9303 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6947
Practice Address - Country:US
Practice Address - Phone:954-345-7050
Practice Address - Fax:954-345-7050
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2583152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65-0876911OtherPROVIDER ID
FL910346OtherPROVIDER ID