Provider Demographics
NPI:1619681525
Name:CAMPBELL-HARKNESS, CHRISTINA JODY-ANN
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JODY-ANN
Last Name:CAMPBELL-HARKNESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711B SEAGIRT AVE APT 11J
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5735
Mailing Address - Country:US
Mailing Address - Phone:929-888-0185
Mailing Address - Fax:
Practice Address - Street 1:7 11 SEAGIRT AVENUE
Practice Address - Street 2:11J
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:212-913-9993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334890-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse