Healthcare Provider Details

I. General information

NPI: 1720545031
Provider Name (Legal Business Name): CHRISTINA LYNN NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA LYNN BROWN

II. Dates (important events)

Enumeration Date: 02/22/2019
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2748 S FALKENBURG RD
RIVERVIEW FL
33578-2561
US

IV. Provider business mailing address

2748 S FALKENBURG RD
RIVERVIEW FL
33578-2561
US

V. Phone/Fax

Practice location:
  • Phone: 443-742-7937
  • Fax:
Mailing address:
  • Phone: 813-599-2769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberRBT-19-79149
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-53987
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-79149
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: