Provider Demographics
NPI:1912461724
Name:LARSEN, CHRISTINA ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANN
Last Name:LARSEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:ANN
Other - Last Name:DICARLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 NEWARK ST APT 6C
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2448
Mailing Address - Country:US
Mailing Address - Phone:646-369-9137
Mailing Address - Fax:
Practice Address - Street 1:160 E 53RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5243
Practice Address - Country:US
Practice Address - Phone:212-610-0589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343972363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily