Provider Demographics
NPI:1225655087
Name:HARVEY, CHRISTINA NICHOLE
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:NICHOLE
Last Name:HARVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:CHARLES
Other - Middle Name:EDWARD
Other - Last Name:HAYNES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HEART OF GOLD AGENCY
Mailing Address - Street 1:6249 EDGEWATER DR # V1
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-4739
Mailing Address - Country:US
Mailing Address - Phone:407-733-8289
Mailing Address - Fax:844-388-0438
Practice Address - Street 1:410 SUNNYVIEW CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-6279
Practice Address - Country:US
Practice Address - Phone:407-733-8289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-28
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107353600Medicaid