Provider Demographics
NPI:1366751463
Name:STANDIFORD, CHRISTEN FAITH (ANP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:FAITH
Last Name:STANDIFORD
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6220
Mailing Address - Country:US
Mailing Address - Phone:912-350-1316
Mailing Address - Fax:912-350-2156
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-350-1316
Practice Address - Fax:912-350-2156
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN175956363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003101427AMedicaid
GA583507OtherWELLCARE
SCNP1727Medicaid
01410460OtherAMERIGROUP
GAP00933356OtherRR MEDICARE
GA003101427AMedicaid