Provider Demographics
NPI:1013271592
Name:CHRISTIE, JEREMY JOHN (FNP-C)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:JOHN
Last Name:CHRISTIE
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26800 CROWN VALLEY PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8018
Mailing Address - Country:US
Mailing Address - Phone:949-276-2111
Mailing Address - Fax:
Practice Address - Street 1:26800 CROWN VALLEY PKWY STE 150
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8018
Practice Address - Country:US
Practice Address - Phone:949-276-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031545363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty