Provider Demographics
NPI:1275599227
Name:PHILLIPS, CHRISTINA HAYNES (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:HAYNES
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8368 ELK GROVE FLORIN RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-9228
Mailing Address - Country:US
Mailing Address - Phone:916-453-5143
Mailing Address - Fax:916-286-6639
Practice Address - Street 1:2425 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2215
Practice Address - Country:US
Practice Address - Phone:916-453-2049
Practice Address - Fax:916-453-2373
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308680363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily