Basic Information
| Provider Information | |||||||||
| NPI: | 1073860359 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FALLACARO | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | |||||||||
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| Credential: | CNM MSN ARNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LEWIS | ||||||||
| OtherFirstName: | CHRISTINA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8110 ROYAL PALM BLVD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330655795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543418288 | ||||||||
| FaxNumber: | 9543415165 | ||||||||
| Practice Location | |||||||||
| Address1: | 8110 ROYAL PALM BLVD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330655795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543418288 | ||||||||
| FaxNumber: | 9543415165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2012 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP9282427 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 367A00000X | ARNP9282427 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 013558500 | 05 | FL | MEDICAID |