Provider Demographics
NPI:1689649634
Name:BOLTERSDORF, CHRISTOPHER (PA-C)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:BOLTERSDORF
Suffix:
Gender:M
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 1:460 E ALTAMONTE DR STE 2200
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4653
Mailing Address - Country:US
Mailing Address - Phone:407-767-0009
Mailing Address - Fax:407-767-0022
Practice Address - Street 1:460 E ALTAMONTE DR STE 2200
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4653
Practice Address - Country:US
Practice Address - Phone:407-767-0009
Practice Address - Fax:407-767-0022
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9102218OtherPHYSICIAN'S ASST. NO
FLPA9102218OtherPHYSICIAN'S ASST. NO