MEDICARE: MS. PATRICIA MARLENA CHRISTOPHERSON P.A.-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	PA9104285	FL
2	363AM0700X	Medical Physician Assistant	51979	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CQ690Y	OTHER	FL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA9104285	OTHER	FL	PA LICENSE
2	51979	OTHER	CA	PALICENSE

General Provider Information

NPI Number	:	1659510261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA MARLENA CHRISTOPHERSON P.A.-C.

Provider Business Mailing Address
First Line	:	8500 BALBOA BLVD
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91325-5802
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 BETH STACEY BLVD
Second Line	:	SUITE 130
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-6074
Country	:	US
Telephone Number	:	239-369-4088
Fax Number	:	239-369-0588

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

Provider Enumeration Date	:	02/05/2009
Last Update Date	:	01/16/2026

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