Provider Demographics
NPI:1558368753
Name:SHORE, CHRISTIE D (ARNP)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:D
Last Name:SHORE
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 1:3775 WINKLER AVENUE EXT
Mailing Address - Street 2:APT. 524
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-7739
Mailing Address - Country:US
Mailing Address - Phone:239-936-4129
Mailing Address - Fax:
Practice Address - Street 1:10501 FGCU BLVD S
Practice Address - Street 2:STUDENT HEALTH CENTER/FGCU
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33965-6502
Practice Address - Country:US
Practice Address - Phone:239-590-7966
Practice Address - Fax:239-590-7968
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1300302363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health