Provider Demographics
NPI:1316525322
Name:CHRISTISON, JASON ANDREW (APRN)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ANDREW
Last Name:CHRISTISON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 CHUMUCKLA HWY
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-1001
Mailing Address - Country:US
Mailing Address - Phone:850-889-8181
Mailing Address - Fax:866-333-5829
Practice Address - Street 1:4515 CHUMUCKLA HWY
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-1001
Practice Address - Country:US
Practice Address - Phone:850-889-8181
Practice Address - Fax:866-333-5829
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11012606363L00000X
FLAPRN9432177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner