Provider Demographics
NPI:1437199486
Name:WITTMANN, CHRISTOPHER J (PAC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:WITTMANN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8146 CEREBELLUM WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1784
Mailing Address - Country:US
Mailing Address - Phone:727-264-8865
Mailing Address - Fax:727-608-4479
Practice Address - Street 1:8146 CEREBELLUM WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1784
Practice Address - Country:US
Practice Address - Phone:727-264-8865
Practice Address - Fax:727-608-4479
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102804363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4227WMedicare PIN