MEDICARE: CHRISTINE MARIE FARGO ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP3328432	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770584542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE MARIE FARGO ARNP

Provider Business Mailing Address
First Line	:	PO BOX 561600
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32956-1600
Country	:	US
Telephone Number	:	321-868-8320
Fax Number	:	321-632-3445

Provider Business Practice Location Address
First Line	:	2300 STATE ROAD 524
Second Line	:	SUITE 104
City	:	COCOA
State	:	FL
Zip	:	32926-5894
Country	:	US
Telephone Number	:	321-868-8320
Fax Number	:	321-632-3445

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	05/29/2018

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