Provider Demographics
NPI:1851073993
Name:IRIZARRY, CHRISTOPHER JASON
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JASON
Last Name:IRIZARRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3627 UNIVERSITY BLVD S STE 305
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4294
Mailing Address - Country:US
Mailing Address - Phone:904-596-0760
Mailing Address - Fax:904-398-1729
Practice Address - Street 1:3627 UNIVERSITY BLVD S STE 305
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4294
Practice Address - Country:US
Practice Address - Phone:904-596-0760
Practice Address - Fax:904-398-1729
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9117991363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant