Healthcare Provider Details

I. General information

NPI: 1205399664
Provider Name (Legal Business Name): CHRISTINA MARIE DODDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 COSTA DEL SOL
BOCA RATON FL
33432-1746
US

IV. Provider business mailing address

1100 SW 19TH ST
BOCA RATON FL
33486-6712
US

V. Phone/Fax

Practice location:
  • Phone: 561-802-7874
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11000017
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberARNP11000017
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: