Healthcare Provider Details

I. General information

NPI: 1023616083
Provider Name (Legal Business Name): CHRISTIN BAGLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTIN DELANEY

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 BLANDING BLVD
ORANGE PARK FL
32065-6206
US

IV. Provider business mailing address

906 BLANDING BLVD
ORANGE PARK FL
32065-6206
US

V. Phone/Fax

Practice location:
  • Phone: 850-319-1491
  • Fax:
Mailing address:
  • Phone: 904-213-4444
  • Fax: 904-213-9113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11009641
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: