Healthcare Provider Details

I. General information

NPI: 1104271444
Provider Name (Legal Business Name): CHRISTY M CHONG ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2016
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 OLD MOULTRIE RD STE A
SAINT AUGUSTINE FL
32084-4167
US

IV. Provider business mailing address

1851 OLD MOULTRIE RD STE A
SAINT AUGUSTINE FL
32084-4167
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-8088
  • Fax: 904-826-4105
Mailing address:
  • Phone: 904-824-8088
  • Fax: 904-826-4105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9229375
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: