Provider Demographics
NPI:1487995353
Name:JOGI, CHRISTINE TYLER (FNP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:TYLER
Last Name:JOGI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15500 LUNDY PKWY
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2778
Mailing Address - Country:US
Mailing Address - Phone:734-981-1086
Mailing Address - Fax:
Practice Address - Street 1:2050 N HAGGERTY RD
Practice Address - Street 2:STE 100
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3795
Practice Address - Country:US
Practice Address - Phone:734-981-1086
Practice Address - Fax:734-981-5094
Is Sole Proprietor?:No
Enumeration Date:2013-03-02
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704275304363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily