Provider Demographics
NPI:1558673186
Name:PROKOP, CHRISTINA MARIE (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:PROKOP
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:KLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:30 HAGEN DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2658
Mailing Address - Country:US
Mailing Address - Phone:585-922-0150
Mailing Address - Fax:
Practice Address - Street 1:30 HAGEN DR STE 300
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2658
Practice Address - Country:US
Practice Address - Phone:585-922-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2016-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014065363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400039842/70008A GPMedicare UPIN
NYJ400039843/BA0017 GPMedicare PIN