Provider Demographics
NPI:1720395700
Name:JAFFE, CHRISTINE M (CPNP, MS, RN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:JAFFE
Suffix:
Gender:F
Credentials:CPNP, MS, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-7474
Mailing Address - Fax:239-343-4190
Practice Address - Street 1:16230 SUMMERLIN RD STE 215
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-5769
Practice Address - Country:US
Practice Address - Phone:239-343-7474
Practice Address - Fax:239-343-4190
Is Sole Proprietor?:No
Enumeration Date:2010-09-11
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37580363LP0200X
MARN2262105363LP0200X
FLAPRN11005672363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110020639BMedicaid
FL115886100Medicaid
RICH83544Medicaid