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General NPI Number Information
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NPI Number | 1225830185
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Entity Type | Individual
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Provider Name | CHRISTOPHER TYLER STATEN
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Gender |
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 1394 DUNLAWTON AVE APT 308
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City | PORT ORANGE
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State | FL
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Zip | 32127-4760
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Country | US
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Telephone | 304-962-8953
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Fax |
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Provider Business Mailing Address
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Address Line | 1394 DUNLAWTON AVE APT 308
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City | PORT ORANGE
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State | FL
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Zip | 32127-4760
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Country | US
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Telephone | 304-962-8953
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Fax | 304-962-8953
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | PSI46436
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License Number State | FL
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