Basic Information
| Provider Information | |||||||||
| NPI: | 1376016048 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUNDSTEDT | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | SUZANNE | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 S PARK RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330218541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669862263 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5395 RUFFIN RD STE 204 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585713630 | ||||||||
| FaxNumber: | 8584303146 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2019 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 95009138 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 11009616 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.