Healthcare Provider Details

I. General information

NPI: 1043031115
Provider Name (Legal Business Name): PROF. CHRISTIAN FRAZIER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S ASHLEY DR STE 600
TAMPA FL
33602-5300
US

IV. Provider business mailing address

100 S ASHLEY DR STE 600
TAMPA FL
33602-5300
US

V. Phone/Fax

Practice location:
  • Phone: 813-731-6709
  • Fax:
Mailing address:
  • Phone: 813-731-6709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number3758428
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: