Healthcare Provider Details

I. General information

NPI: 1578710315
Provider Name (Legal Business Name): J CHRISTIE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2008
Last Update Date: 08/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2407 CYPRESS RIDGE BLVD
WESLEY CHAPEL FL
33544-6312
US

IV. Provider business mailing address

6094 14TH ST W # 119
BRADENTON FL
34207-4104
US

V. Phone/Fax

Practice location:
  • Phone: 813-357-5900
  • Fax:
Mailing address:
  • Phone: 941-360-1566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOAN M CHRISTIE
Title or Position: PRESIDENT
Credential: MD
Phone: 941-360-1566