Provider Demographics
NPI:1124677893
Name:PRINCE, CHRISTINA IRENE (MSN, RN, FNP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:IRENE
Last Name:PRINCE
Suffix:
Gender:F
Credentials:MSN, RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1894
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-1894
Mailing Address - Country:US
Mailing Address - Phone:615-522-8421
Mailing Address - Fax:
Practice Address - Street 1:1544 BASS RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-7510
Practice Address - Country:US
Practice Address - Phone:478-471-4494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN187027163W00000X, 163WM0705X
TN93502363L00000X, 363LF0000X
GARN293292363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN293292OtherADVANCED PRACTICE REGISTERED NURSE - NP