Provider Demographics
NPI:1063068674
Name:PROSKOFF, KRISTINA (NP)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:
Last Name:PROSKOFF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:GOLOVNINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24574B 77TH CRES
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-1884
Mailing Address - Country:US
Mailing Address - Phone:347-822-9272
Mailing Address - Fax:
Practice Address - Street 1:24574B 77TH CRES
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-1884
Practice Address - Country:US
Practice Address - Phone:347-822-9272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-11
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311623363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health