Provider Demographics
NPI:1063636611
Name:JASSIR, CHRISTINE (ARNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:JASSIR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 SHERIDAN ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3420
Mailing Address - Country:US
Mailing Address - Phone:954-966-7000
Mailing Address - Fax:954-966-7095
Practice Address - Street 1:4700 SHERIDAN ST
Practice Address - Street 2:SUITE K
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3420
Practice Address - Country:US
Practice Address - Phone:954-966-7000
Practice Address - Fax:954-966-7095
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP31444032363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ36398Medicare UPIN
FLU4248WMedicare PIN