Provider Demographics
NPI:1104124494
Name:ZIMMERMAN, CHRISTINA TEEGARDEN (RN,MS,CPNP)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:TEEGARDEN
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:RN,MS,CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93128
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14692-8128
Mailing Address - Country:US
Mailing Address - Phone:585-442-9271
Mailing Address - Fax:
Practice Address - Street 1:2711 CLOVER ST
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1049
Practice Address - Country:US
Practice Address - Phone:585-442-9271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380788-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics