Healthcare Provider Details

I. General information

NPI: 1922538586
Provider Name (Legal Business Name): CHRISTINA LAYTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 SIMMONS LOOP STE 203
RIVERVIEW FL
33578-9498
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 813-302-8718
  • Fax:
Mailing address:
  • Phone: 727-315-7496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS20716
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: