Healthcare Provider Details

I. General information

NPI: 1992977003
Provider Name (Legal Business Name): CHRISTINA MARIE WOMBLES ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E PRINCETON ST STE 540
ORLANDO FL
32803-1424
US

IV. Provider business mailing address

615 E PRINCETON ST STE 540
ORLANDO FL
32803-1424
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-8127
  • Fax: 407-303-8197
Mailing address:
  • Phone: 407-303-8127
  • Fax: 407-303-8197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2013018582
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberARNP9219054
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: