Healthcare Provider Details

I. General information

NPI: 1780549972
Provider Name (Legal Business Name): CHRISTINA CORTEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 SW INNOVATION WAY
PORT SAINT LUCIE FL
34987-2111
US

IV. Provider business mailing address

11278 SW KINGSLAKE CIR
PORT SAINT LUCIE FL
34987-2761
US

V. Phone/Fax

Practice location:
  • Phone: 646-922-3079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number69258
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: