Provider Demographics
NPI:1134381197
Name:HALL, CHRISTA L (PA)
Entity type:Individual
Prefix:MISS
First Name:CHRISTA
Middle Name:L
Last Name:HALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6011 CORTEZ RD W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-2709
Mailing Address - Country:US
Mailing Address - Phone:941-792-5040
Mailing Address - Fax:941-792-5026
Practice Address - Street 1:6011 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2709
Practice Address - Country:US
Practice Address - Phone:941-792-5040
Practice Address - Fax:941-792-5026
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPA9104596363AS0400X
FLPA9104596363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46721OtherBCBS OF FLORIDA
FL46721OtherBCBS OF FLORIDA