Provider Demographics
NPI:1013207489
Name:KRISTOFIC, DEANNA JANE (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:JANE
Last Name:KRISTOFIC
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MS
Other - First Name:DEANNA
Other - Middle Name:JANE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:4680 ABLE AVE
Mailing Address - Street 2:
Mailing Address - City:KANAB
Mailing Address - State:UT
Mailing Address - Zip Code:84741-8161
Mailing Address - Country:US
Mailing Address - Phone:928-640-7914
Mailing Address - Fax:
Practice Address - Street 1:167 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045-0600
Practice Address - Country:US
Practice Address - Phone:928-283-2501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4267363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health