Provider Demographics
NPI:1841057833
Name:WHITEHEAD, CRISTINA (FNP)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 EXCHANGE DR
Mailing Address - Street 2:
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078-9198
Mailing Address - Country:US
Mailing Address - Phone:803-408-3277
Mailing Address - Fax:
Practice Address - Street 1:690 COLUMBIANA DR STE B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1656
Practice Address - Country:US
Practice Address - Phone:803-736-3277
Practice Address - Fax:803-408-8698
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF09230966363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily