Healthcare Provider Details

I. General information

NPI: 1659753689
Provider Name (Legal Business Name): CHRISTINA M GARCIA AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 06/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 TREBBE DR
MANCHESTER CT
06040-2621
US

IV. Provider business mailing address

74 TREBBE DR
MANCHESTER CT
06040-2621
US

V. Phone/Fax

Practice location:
  • Phone: 203-687-3104
  • Fax:
Mailing address:
  • Phone: 203-687-3104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number94277
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number6141
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: