Provider Demographics
NPI:1902379563
Name:HASTINGS, PAUL (PA-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:HASTINGS
Suffix:
Gender:M
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:PO BOX 960
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-0212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PENINSULA COMMUNITY HEALTH SERVICES
Practice Address - Street 2:400 WARREN AVE, SUITE 200
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337
Practice Address - Country:US
Practice Address - Phone:360-478-2366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61039322363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant