Healthcare Provider Details

I. General information

NPI: 1497517346
Provider Name (Legal Business Name): CHRISTINE CERAVOLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 UNIVERSITY BLVD STE 201
JUPITER FL
33458-2795
US

IV. Provider business mailing address

2586 LIVINGSTON LN
WEST PALM BEACH FL
33411-5743
US

V. Phone/Fax

Practice location:
  • Phone: 561-882-6060
  • Fax:
Mailing address:
  • Phone: 561-346-3549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11030444
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: