Provider Demographics
NPI:1356688717
Name:COFER, KRISTEN C (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:C
Last Name:COFER
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 1:2730 N MCMULLEN BOOTH RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3302
Mailing Address - Country:US
Mailing Address - Phone:727-474-7411
Mailing Address - Fax:727-245-8879
Practice Address - Street 1:2730 N MCMULLEN BOOTH RD STE 202
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3302
Practice Address - Country:US
Practice Address - Phone:727-474-7411
Practice Address - Fax:833-974-2140
Is Sole Proprietor?:No
Enumeration Date:2013-01-05
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106976363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant