Provider Demographics
NPI:1740641877
Name:CHRISTIE, SARA SHAPRE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:SHAPRE
Last Name:CHRISTIE
Suffix:
Gender:F
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 1:615 HALTON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607
Mailing Address - Country:US
Mailing Address - Phone:864-676-1707
Mailing Address - Fax:864-676-9256
Practice Address - Street 1:615 HALTON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607
Practice Address - Country:US
Practice Address - Phone:864-676-1707
Practice Address - Fax:864-676-1707
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20054363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20054OtherSTATE LICENSE