Provider Demographics
NPI:1114138468
Name:JAGGI, CHRISTINE M (PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:JAGGI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23742
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33623-3742
Mailing Address - Country:US
Mailing Address - Phone:813-810-2235
Mailing Address - Fax:813-496-0400
Practice Address - Street 1:14250 49TH STREET N
Practice Address - Street 2:H3014
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762
Practice Address - Country:US
Practice Address - Phone:813-810-2235
Practice Address - Fax:813-496-0400
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6329103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical