Provider Demographics
NPI:1194974188
Name:WALLER, CHRISTAL ALANTHA (APN)
Entity type:Individual
Prefix:MRS
First Name:CHRISTAL
Middle Name:ALANTHA
Last Name:WALLER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:CHRISTAL
Other - Middle Name:SAFFORD
Other - Last Name:WALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:727-322-3439
Mailing Address - Fax:
Practice Address - Street 1:6720 GRELOT RD STE D
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-2698
Practice Address - Country:US
Practice Address - Phone:251-444-1999
Practice Address - Fax:251-444-1998
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-058493363LF0000X
FLAPRN11026008363LF0000X
LAAP09037363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP09037OtherADVANCED PRACTICE REGISTERED NURSE
ARA03113OtherARKANSAS STATE BOARD OF NURSING
MW1834375OtherDRUG ENFORCEMENT ADMINISTRATION