Provider Demographics
NPI:1508190588
Name:PROKOP, CRISTINA ELIZABETH (APRN)
Entity Type:Individual
Prefix:MS
First Name:CRISTINA
Middle Name:ELIZABETH
Last Name:PROKOP
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:81 MAKAWAO AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8859
Mailing Address - Country:US
Mailing Address - Phone:808-573-8900
Mailing Address - Fax:808-572-3027
Practice Address - Street 1:81 MAKAWAO AVE STE 100
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8859
Practice Address - Country:US
Practice Address - Phone:808-573-8900
Practice Address - Fax:808-572-3027
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1124363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health