MEDICARE: DR. CHRISTINA DIANE PETERS PH.D.

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	103T00000X	Psychologist	PY8409	FL

General Provider Information

NPI Number	:	1750667242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINA DIANE PETERS PH.D.

Provider Business Mailing Address
First Line	:	13907 N DALE MABRY HWY
Second Line	:	SUITE 204
City	:	TAMPA
State	:	FL
Zip	:	33618-2411
Country	:	US
Telephone Number	:	813-419-2683
Fax Number	:

Provider Business Practice Location Address
First Line	:	13907 N DALE MABRY HWY
Second Line	:	SUITE 204
City	:	TAMPA
State	:	FL
Zip	:	33618-2411
Country	:	US
Telephone Number	:	813-419-2683
Fax Number	:

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

Provider Enumeration Date	:	10/27/2011
Last Update Date	:	10/27/2011

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