Provider Demographics
NPI:1497527121
Name:SAN JUAN, CHRISTIA MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTIA MARIE
Middle Name:
Last Name:SAN JUAN
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 1:103 N 23RD ST
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1213
Mailing Address - Country:US
Mailing Address - Phone:732-640-4602
Mailing Address - Fax:
Practice Address - Street 1:103 N 23RD ST
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033-1213
Practice Address - Country:US
Practice Address - Phone:732-640-4602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14919600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily