Healthcare Provider Details

I. General information

NPI: 1346773900
Provider Name (Legal Business Name): MRS. CHRISTIANE PREVILMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 LAKE WORTH RD STE 201
GREENACRES FL
33463-4727
US

IV. Provider business mailing address

5700 LAKE WORTH RD STE 201
GREENACRES FL
33463-4727
US

V. Phone/Fax

Practice location:
  • Phone: 561-510-6321
  • Fax:
Mailing address:
  • Phone: 561-545-1019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN9499155
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11044295
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: