Provider Demographics
NPI:1679890719
Name:HERRERA, CHRISTINA ANNETTE (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANNETTE
Last Name:HERRERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W GORE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1014
Mailing Address - Country:US
Mailing Address - Phone:321-841-8555
Mailing Address - Fax:321-841-2425
Practice Address - Street 1:207 W GORE ST STE 300
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1014
Practice Address - Country:US
Practice Address - Phone:321-841-8555
Practice Address - Fax:321-841-2425
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8844049-1205207VM0101X
FLME151152207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1679890719Medicaid
UTU000086555Medicare PIN