Healthcare Provider Details

I. General information

NPI: 1336757756
Provider Name (Legal Business Name): CHRISTY JO REPARIP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E GORE ST STE 201
ORLANDO FL
32806-1224
US

IV. Provider business mailing address

7824 BOSTONIAN DR
WINTER GARDEN FL
34787-5185
US

V. Phone/Fax

Practice location:
  • Phone: 407-985-1940
  • Fax:
Mailing address:
  • Phone: 941-400-1793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11008093
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: