Provider Demographics
NPI:1780307744
Name:CHRISTIE, JACLYN ELIZABETH (FNP-C)
Entity type:Individual
Prefix:MISS
First Name:JACLYN
Middle Name:ELIZABETH
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:FNP-C
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Mailing Address - Street 1:1215 W BALTIMORE PIKE STE 13
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5540
Mailing Address - Country:US
Mailing Address - Phone:610-565-1919
Mailing Address - Fax:610-566-8971
Practice Address - Street 1:1215 W BALTIMORE PIKE STE 13
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5540
Practice Address - Country:US
Practice Address - Phone:610-565-1919
Practice Address - Fax:610-566-8971
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP026268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP026268OtherPA STATE BOARD OF NURSING