Individual
CHRISTOPHER JACOB BORDELON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2550 W DR MARTIN LUTHER KING JR BLVD STE B, TAMPA, FL 33607-6302
(813) 876-6483
Mailing address
10414 NIGHTENGALE DR, RIVERVIEW, FL 33569-4125
(813) 789-0565
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2018024459
MO
363AM0700X
Medical Physician Assistant
PA9111443
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101257900
—
FL
Enumeration date
07/10/2018
Last updated
09/15/2021
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