Healthcare Provider Details

I. General information

NPI: 1487927570
Provider Name (Legal Business Name): FREDERICK MICHAEL CHRISTENSEN AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2012
Last Update Date: 02/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 US 1 S SUITE 4 A
ST AUGUSTINE FL
32086-6351
US

IV. Provider business mailing address

3100 US 1 S SUITE 4 A
ST AUGUSTINE FL
32086-6351
US

V. Phone/Fax

Practice location:
  • Phone: 904-794-0061
  • Fax: 904-794-0061
Mailing address:
  • Phone: 904-794-0061
  • Fax: 904-794-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY 1712
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAY1712
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: