MEDICARE: CHRISTIE D. SHORE A.R.N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	1300302	FL

General Provider Information

NPI Number	:	1558368753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIE D. SHORE A.R.N.P.

Provider Business Mailing Address
First Line	:	3775 WINKLER AVENUE EXT
Second Line	:	APT. 524
City	:	FORT MYERS
State	:	FL
Zip	:	33916-7739
Country	:	US
Telephone Number	:	239-936-4129
Fax Number	:

Provider Business Practice Location Address
First Line	:	10501 FGCU BLVD S
Second Line	:	STUDENT HEALTH CENTER/FGCU
City	:	FORT MYERS
State	:	FL
Zip	:	33965-6502
Country	:	US
Telephone Number	:	239-590-7966
Fax Number	:	239-590-7968

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	01/13/2011

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