Healthcare Provider Details

I. General information

NPI: 1710819446
Provider Name (Legal Business Name): BIANCA CHRISTIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5611 PLACE LAKE DR
FORT PIERCE FL
34951-3138
US

IV. Provider business mailing address

5611 PLACE LAKE DR
FORT PIERCE FL
34951-3138
US

V. Phone/Fax

Practice location:
  • Phone: 772-323-8691
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2026019492
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: