Provider Demographics
NPI:1942976238
Name:WALLS, CHRISTY SUZANNE (FNP-C)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:SUZANNE
Last Name:WALLS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 NORTHLAKE BLVD STE 1008
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4335
Mailing Address - Country:US
Mailing Address - Phone:407-834-3300
Mailing Address - Fax:
Practice Address - Street 1:270 NORTHLAKE BLVD STE 1008
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4335
Practice Address - Country:US
Practice Address - Phone:407-834-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11014758363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner