Provider Demographics
NPI:1750631669
Name:KING, CHRISTIE (APRN)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:KING
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 AMBOY DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-4429
Mailing Address - Country:US
Mailing Address - Phone:386-248-6798
Mailing Address - Fax:
Practice Address - Street 1:24239 STATE ROAD 40
Practice Address - Street 2:
Practice Address - City:ASTOR
Practice Address - State:FL
Practice Address - Zip Code:32102-3029
Practice Address - Country:US
Practice Address - Phone:352-759-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11014867363LF0000X
MECNP121086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily