Healthcare Provider Details

I. General information

NPI: 1255246898
Provider Name (Legal Business Name): CHRISTOPHER K BRANUM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 HOLIDAY DR
EUSTIS FL
32726-7323
US

IV. Provider business mailing address

1250 HOLIDAY DR
EUSTIS FL
32726-7323
US

V. Phone/Fax

Practice location:
  • Phone: 352-434-4279
  • Fax:
Mailing address:
  • Phone: 352-434-4279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPSI47171
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: