Organization Name: | ANTI-AGING MEDICAL CENTER |
NPI Number: | 1265795207 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHRISTINA M PARKER (OWNER/ARNP) |
Mailing Address: | 3545 Bobcat Village Center Rd North Port |
State: | FL US |
Postal Code: | 342888977 |
Phone Number: | 9416250304 |
Fax Number: | |
NPI Enumeration Date: | 06/22/2012 |
NPI Last Update Date: | 06/22/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 9267806 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |