Provider Demographics
NPI:1376818427
Name:JOCHUM, KRISTIN L (MPAS, PA-C)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:L
Last Name:JOCHUM
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
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Mailing Address - Street 1:8926 77TH TER E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-6417
Mailing Address - Country:US
Mailing Address - Phone:941-907-0222
Mailing Address - Fax:
Practice Address - Street 1:8926 77TH TER E
Practice Address - Street 2:UNIT 101
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-6417
Practice Address - Country:US
Practice Address - Phone:941-907-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9106074363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant