Healthcare Provider Details

I. General information

NPI: 1265146708
Provider Name (Legal Business Name): CHRISTY LENT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MEMORIAL MEDICAL PKWY STE 301
DAYTONA BEACH FL
32117-5157
US

IV. Provider business mailing address

305 MEMORIAL MEDICAL PKWY STE 301
DAYTONA BEACH FL
32117-5157
US

V. Phone/Fax

Practice location:
  • Phone: 386-615-1521
  • Fax: 386-671-0694
Mailing address:
  • Phone: 386-615-1521
  • Fax: 386-671-0694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0123028
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF01230236
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: