Provider Demographics
NPI:1497305486
Name:JARVIS, KRISTINA ANELE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANELE
Last Name:JARVIS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HANCOCK ST APT 208
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-1760
Mailing Address - Country:US
Mailing Address - Phone:603-234-5762
Mailing Address - Fax:
Practice Address - Street 1:2 HANCOCK ST APT 208
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-1760
Practice Address - Country:US
Practice Address - Phone:603-234-5762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2293746363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily