Provider Demographics
NPI:1336578277
Name:SERVOSS, CHRISTOPHER SPENCER (ARNP)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:SPENCER
Last Name:SERVOSS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 TALL PINE CIR
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-5204
Mailing Address - Country:US
Mailing Address - Phone:727-725-4940
Mailing Address - Fax:727-725-5678
Practice Address - Street 1:1701 TALL PINE CIR
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-5204
Practice Address - Country:US
Practice Address - Phone:727-725-4940
Practice Address - Fax:727-725-5678
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9268461363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010355300Medicaid
FL010355300Medicaid