Provider Demographics
NPI:1073370193
Name:WHITTWELL, CHRISTOPHER HENRY (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:HENRY
Last Name:WHITTWELL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5444 SW 149TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4018
Mailing Address - Country:US
Mailing Address - Phone:305-283-7705
Mailing Address - Fax:
Practice Address - Street 1:1100 S STATE ROAD 7 STE 201
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33068-4033
Practice Address - Country:US
Practice Address - Phone:754-229-6886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9118572363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant