Provider Demographics
NPI:1013753243
Name:EDWARDS, CHRISTINA JOCKLENE (AGPCNP-C)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JOCKLENE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:172 HUNTERS MILL LN
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-1279
Mailing Address - Country:US
Mailing Address - Phone:843-240-3041
Mailing Address - Fax:
Practice Address - Street 1:2750 LAUREL ST STE 103
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2023
Practice Address - Country:US
Practice Address - Phone:803-865-4934
Practice Address - Fax:803-865-4935
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC28779208800000X, 363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208800000XAllopathic & Osteopathic PhysiciansUrology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care