Healthcare Provider Details

I. General information

NPI: 1811479728
Provider Name (Legal Business Name): CHRISTOPHER CORRIVEAU ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 NURSING HOME DR
ARCADIA FL
34266-3839
US

IV. Provider business mailing address

425 NURSING HOME DR
ARCADIA FL
34266-3839
US

V. Phone/Fax

Practice location:
  • Phone: 863-993-7296
  • Fax: 863-494-5491
Mailing address:
  • Phone: 863-993-2966
  • Fax: 863-494-5491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9376103
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9376103
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: