Provider Demographics
NPI:1508308859
Name:MEADE, CHRISTIAN NATHANIEL (DNP)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:NATHANIEL
Last Name:MEADE
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 SWEET OAK WAY
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-8999
Mailing Address - Country:US
Mailing Address - Phone:276-275-9644
Mailing Address - Fax:
Practice Address - Street 1:3955 LEWIS SPEEDWAY
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-8611
Practice Address - Country:US
Practice Address - Phone:904-209-1579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174304363L00000X
TN28495363L00000X
FLARNP9368910363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner