Healthcare Provider Details

I. General information

NPI: 1154896165
Provider Name (Legal Business Name): CHRISTINA ALANA DEBOW ACUPUNCTURIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 S DIXIE HWY STE C1
SAINT AUGUSTINE FL
32084-4183
US

IV. Provider business mailing address

2501 HYDRANGEA ST
ST AUGUSTINE FL
32080-5885
US

V. Phone/Fax

Practice location:
  • Phone: 904-671-4046
  • Fax:
Mailing address:
  • Phone: 904-671-4046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number9248453
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number32334
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number3967
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: