Provider Demographics
NPI:1548876824
Name:BRIM, CHRISTOPHER W (APRN)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:W
Last Name:BRIM
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N MANGOUSTINE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1004
Mailing Address - Country:US
Mailing Address - Phone:407-833-7505
Mailing Address - Fax:
Practice Address - Street 1:863 TAMERLANE ST
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5545
Practice Address - Country:US
Practice Address - Phone:321-624-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11009271363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily