Provider Demographics
NPI:1871835637
Name:CHRISTMAN, JACQUELINE PAGE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:PAGE
Last Name:CHRISTMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:SELLERS
Other - Last Name:CHRISTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:550 SOUTH PIKE WEST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2664
Mailing Address - Country:US
Mailing Address - Phone:803-774-4936
Mailing Address - Fax:803-774-4936
Practice Address - Street 1:1278 N. LAFAYETTE DR.
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2664
Practice Address - Country:US
Practice Address - Phone:803-774-4500
Practice Address - Fax:803-774-4525
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18118363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2399Medicaid
SCNP2399Medicaid