Provider Demographics
NPI:1912171737
Name:NEAL, CHRISTOPHER GOFF (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:GOFF
Last Name:NEAL
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 335
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-0335
Mailing Address - Country:US
Mailing Address - Phone:727-871-3710
Mailing Address - Fax:727-712-1548
Practice Address - Street 1:1011 JEFFORDS ST
Practice Address - Street 2:SUITE D
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4070
Practice Address - Country:US
Practice Address - Phone:727-871-3710
Practice Address - Fax:727-712-1548
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104543363AS0400X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593317557OtherTIN