Provider Demographics
NPI:1194818120
Name:REIFENSTEIN, CHRIS B (PA)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:B
Last Name:REIFENSTEIN
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 1:27406 CASHFORD CIR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-8199
Mailing Address - Country:US
Mailing Address - Phone:813-994-8900
Mailing Address - Fax:855-388-5350
Practice Address - Street 1:27406 CASHFORD CIR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-8199
Practice Address - Country:US
Practice Address - Phone:813-994-8900
Practice Address - Fax:813-793-7386
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103645363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q65625Medicare UPIN
U70392Medicare ID - Type Unspecified