Bordelon, Christopher Jacob

Bordelon, Christopher Jacob is an individual health care provider with primary practice located at 2550 W Dr Martin Luther King Jr Blvd Ste B , Tampa FL 33607-6302. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Bordelon, Christopher Jacob can be contacted via phone (813) 876-6483.

Contact Information

Primary practice address
2550 W Dr Martin Luther King Jr Blvd Ste B Tampa FL 33607-6302
Phone: (813) 876-6483
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA9111443 Florida
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 2018024459 Missouri

Profile Details

NPI number 1548756893
LBN Legal business name Bordelon, Christopher Jacob
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 10th, 2018
Last updated Sep 15th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548756893 NPPES
Florida MEDICAID 101257900

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