MEDICARE: CHRISTINA NICOLE PROULX PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	9114040	FL

General Provider Information

NPI Number	:	1538754973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA NICOLE PROULX PA-C

Provider Business Mailing Address
First Line	:	15280 S JOG RD STE B
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-2169
Country	:	US
Telephone Number	:	561-495-9797
Fax Number	:

Provider Business Practice Location Address
First Line	:	15280 S JOG RD STE B
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-2169
Country	:	US
Telephone Number	:	561-573-0539
Fax Number	:	561-499-9098

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2021
Last Update Date	:	05/15/2023

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Directions to “ CHRISTINA NICOLE PROULX PA-C” Practice Location

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