Provider Demographics
NPI:1437126703
Name:ACKER, CHRISTINE M (ARNP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:ACKER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 REGENT BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-5806
Mailing Address - Country:US
Mailing Address - Phone:214-689-8079
Mailing Address - Fax:
Practice Address - Street 1:3050 REGENT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-5806
Practice Address - Country:US
Practice Address - Phone:214-689-8079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-04
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9406470363L00000X
OH07287363L00000X
OHCOA-07287-NP363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2641252Medicaid
ACNP14783Medicare PIN