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General NPI Number Information
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NPI Number | 1194409664
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Entity Type | Individual
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Provider Name | CHRISTINE MARIE JOSEPH PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/14/2023
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Last Update Date | 01/28/2024
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Provider Practice Location Address
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Address Line | 3122 NEW BERLIN RD
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City | JACKSONVILLE
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State | FL
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Zip | 32226-1828
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Country | US
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Telephone | 904-633-0340
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Fax |
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Provider Business Mailing Address
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Address Line | 700 QUEENS HARBOR BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32225-4901
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9117941
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License Number State | FL
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