Provider Demographics
NPI:1972555795
Name:CARPENTER, CHRISTINE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7981 GLADIOLUS DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4154
Mailing Address - Country:US
Mailing Address - Phone:239-939-0999
Mailing Address - Fax:239-939-1070
Practice Address - Street 1:7981 GLADIOLUS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4154
Practice Address - Country:US
Practice Address - Phone:239-939-0999
Practice Address - Fax:239-939-1070
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9231344363LF0000X
PAVP004327B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ5611154Medicare PIN