Provider Demographics
NPI:1114541075
Name:KNAPP, KRISTOFFER DANIEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KRISTOFFER
Middle Name:DANIEL
Last Name:KNAPP
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 1:2809 GLENARYE DR
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-7925
Mailing Address - Country:US
Mailing Address - Phone:904-762-4940
Mailing Address - Fax:
Practice Address - Street 1:2809 GLENARYE DR
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-7925
Practice Address - Country:US
Practice Address - Phone:904-762-4940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant