Provider Demographics
NPI:1922584507
Name:KRISTAN, JEFFREY THOMAS (PA-C)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:THOMAS
Last Name:KRISTAN
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 2330
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-2330
Mailing Address - Country:US
Mailing Address - Phone:843-837-4400
Mailing Address - Fax:843-837-4440
Practice Address - Street 1:350 FORDING ISLAND RD STE 100
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-5168
Practice Address - Country:US
Practice Address - Phone:843-837-4400
Practice Address - Fax:843-837-4440
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059875363A00000X
SC3974363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant