Provider Demographics
NPI:1831937465
Name:OTT, CHRISTAL L (FNP)
Entity type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:L
Last Name:OTT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 W 24TH ST STE 26
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8372
Mailing Address - Country:US
Mailing Address - Phone:928-318-6910
Mailing Address - Fax:
Practice Address - Street 1:1025 W 24TH ST STE 26
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8372
Practice Address - Country:US
Practice Address - Phone:928-318-6910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ310403363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily