Provider Demographics
NPI:1790268894
Name:CULLEN, KRISTYN MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:MARIE
Last Name:CULLEN
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 1:16 HONEYCOMB LN
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-1005
Mailing Address - Country:US
Mailing Address - Phone:203-927-0384
Mailing Address - Fax:
Practice Address - Street 1:10383 HAGEN RANCH RD STE 100
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3782
Practice Address - Country:US
Practice Address - Phone:561-203-8518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2019-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant