Healthcare Provider Details

I. General information

NPI: 1679890719
Provider Name (Legal Business Name): CHRISTINA ANNETTE HERRERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W GORE ST STE 300
ORLANDO FL
32806-1014
US

IV. Provider business mailing address

207 W GORE ST STE 300
ORLANDO FL
32806-1014
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-8555
  • Fax: 321-841-2425
Mailing address:
  • Phone: 321-841-8555
  • Fax: 321-841-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number8844049-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberME151152
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: