Provider Demographics
NPI:1689286023
Name:PEREZ, CHRISTAL (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14310 N DALE MABRY HWY STE 305
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2059
Mailing Address - Country:US
Mailing Address - Phone:813-615-7028
Mailing Address - Fax:813-615-8008
Practice Address - Street 1:14310 N DALE MABRY HWY STE 305
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2059
Practice Address - Country:US
Practice Address - Phone:813-615-7028
Practice Address - Fax:813-615-8008
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9971363A00000X
FLPA9118293363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant