Provider Demographics
NPI:1396301206
Name:CARMAN, CHRISTINA VICTORIA
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:VICTORIA
Last Name:CARMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 A SUNNYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084
Mailing Address - Country:US
Mailing Address - Phone:856-905-0637
Mailing Address - Fax:
Practice Address - Street 1:11 SUNNYBROOK RD UNIT A
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1635
Practice Address - Country:US
Practice Address - Phone:856-905-0637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018972363LF0000X
NJ26NJ00870900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily