Provider Demographics
NPI:1831794023
Name:BRAUNWORTH, CHRISTINA (APRN)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BRAUNWORTH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6862 HATTERAS DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7936
Mailing Address - Country:US
Mailing Address - Phone:561-236-8212
Mailing Address - Fax:
Practice Address - Street 1:4710 POINT LOMA AVE APT 5
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-3856
Practice Address - Country:US
Practice Address - Phone:561-236-8212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010341207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine