Healthcare Provider Details

I. General information

NPI: 1700577178
Provider Name (Legal Business Name): CHRISTOPHER PARKER MSN, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BROADWAY
KISSIMMEE FL
34741-5408
US

IV. Provider business mailing address

3145 BELLA VISTA DR
DAVENPORT FL
33897-3664
US

V. Phone/Fax

Practice location:
  • Phone: 405-821-9030
  • Fax:
Mailing address:
  • Phone: 405-821-9030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF05230380
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: