Provider Demographics
NPI:1235670621
Name:BOATRIGHT, CRISTAL (PA-C)
Entity Type:Individual
Prefix:
First Name:CRISTAL
Middle Name:
Last Name:BOATRIGHT
Suffix:
Gender:F
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 1:7741 POINT MEADOWS DR
Mailing Address - Street 2:UNIT 104
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9201
Mailing Address - Country:US
Mailing Address - Phone:904-660-2330
Mailing Address - Fax:
Practice Address - Street 1:7741 POINT MEADOWS DR
Practice Address - Street 2:UNIT 104
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9201
Practice Address - Country:US
Practice Address - Phone:904-660-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-17
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105271363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant