Provider Demographics
NPI:1740449073
Name:HARTER, GINA ANDREA (ACNP-BC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:ANDREA
Last Name:HARTER
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6408 VIA COLINITA
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-6458
Mailing Address - Country:US
Mailing Address - Phone:951-218-2292
Mailing Address - Fax:
Practice Address - Street 1:6408 VIA COLINITA
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-6458
Practice Address - Country:US
Practice Address - Phone:951-218-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA611259163W00000X
CA17775363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse