Healthcare Provider Details

I. General information

NPI: 1144873993
Provider Name (Legal Business Name): CHRISTINE AMALIA VARGA PHD, MSN, APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W ALAMEDA ST
SANTA FE NM
87501-1681
US

IV. Provider business mailing address

810 W SAN MATEO RD
SANTA FE NM
87505-5101
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-8869
  • Fax:
Mailing address:
  • Phone: 505-216-0322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number56708
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number56708
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number56708
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: