Healthcare Provider Details

I. General information

NPI: 1912556473
Provider Name (Legal Business Name): MRS. CHRISTINA JAYE QUIJANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2019
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 W DR MARTIN LUTHER KING JR BLVD
TAMPA FL
33607-6308
US

IV. Provider business mailing address

4070 PACENTE LOOP
WESLEY CHAPEL FL
33543-5439
US

V. Phone/Fax

Practice location:
  • Phone: 813-872-2924
  • Fax:
Mailing address:
  • Phone: 770-313-5964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN9453595
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAPRN11006097
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberAPRN11006097
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: