Healthcare Provider Details

I. General information

NPI: 1093653016
Provider Name (Legal Business Name): CHRISLANA CANTAVE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 KNOCK N KNOLL CIR
WILLOW GROVE PA
19090-1924
US

IV. Provider business mailing address

25 KNOCK N KNOLL CIR
WILLOW GROVE PA
19090-1924
US

V. Phone/Fax

Practice location:
  • Phone: 267-432-6895
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP032407
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: