Provider Demographics
NPI:1750772562
Name:KRAJNIKOVICH, TINA DANIELLE (CRNP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:DANIELLE
Last Name:KRAJNIKOVICH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:DANIELLE
Other - Last Name:LAWALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5647 NASH DR
Mailing Address - Street 2:
Mailing Address - City:PIPERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18947-1119
Mailing Address - Country:US
Mailing Address - Phone:267-566-7946
Mailing Address - Fax:
Practice Address - Street 1:460 VETERANS DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016
Practice Address - Country:US
Practice Address - Phone:267-408-6770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014368363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology