Provider Demographics
NPI:1487927570
Name:CHRISTENSEN, FREDERICK MICHAEL (AUD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:MICHAEL
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 US 1 S
Mailing Address - Street 2:SUITE 4 A
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-6351
Mailing Address - Country:US
Mailing Address - Phone:904-794-0061
Mailing Address - Fax:904-794-0061
Practice Address - Street 1:3100 US 1 S
Practice Address - Street 2:SUITE 4 A
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-6351
Practice Address - Country:US
Practice Address - Phone:904-794-0061
Practice Address - Fax:904-794-0061
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY 1712231H00000X
FLAY1712237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist