Provider Demographics
NPI:1871930743
Name:PROSE, CHRISTINA GAYLE (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:GAYLE
Last Name:PROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:GAYLE
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7240 7TH PL N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-3801
Mailing Address - Country:US
Mailing Address - Phone:561-969-6663
Mailing Address - Fax:561-721-3106
Practice Address - Street 1:7240 7TH PL N
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-3801
Practice Address - Country:US
Practice Address - Phone:561-969-6663
Practice Address - Fax:561-721-3106
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10046757207Q00000X
SC40145207Q00000X
FLME137610207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC401452Medicaid
SCSC9127Medicare PIN