Healthcare Provider Details

I. General information

NPI: 1669010211
Provider Name (Legal Business Name): CHRISTINE ANNE HASBROUCK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 07/24/2024
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMPREHENSIVE CARE MEDICAL LLC 301 OSIGIAN BLVD
WARNER ROBINS GA
31088
US

IV. Provider business mailing address

301 OSIGIAN BLVD
WARNER ROBINS GA
31088
US

V. Phone/Fax

Practice location:
  • Phone: 478-971-2130
  • Fax: 478-971-2131
Mailing address:
  • Phone: 478-971-2130
  • Fax: 478-971-2131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019059752
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: