Healthcare Provider Details

I. General information

NPI: 1508308859
Provider Name (Legal Business Name): CHRISTIAN NATHANIEL MEADE DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 LEWIS SPEEDWAY
ST AUGUSTINE FL
32084-8611
US

IV. Provider business mailing address

349 SWEET OAK WAY
ST AUGUSTINE FL
32095-8999
US

V. Phone/Fax

Practice location:
  • Phone: 904-209-1579
  • Fax:
Mailing address:
  • Phone: 276-275-9644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024174304
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28495
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9368910
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: