Provider Demographics
NPI:1427692292
Name:CARNIGLIA, CHRISTOPHER JOSEPH (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOSEPH
Last Name:CARNIGLIA
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 1:204 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4420
Mailing Address - Country:US
Mailing Address - Phone:407-962-4447
Mailing Address - Fax:407-962-4449
Practice Address - Street 1:204 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4420
Practice Address - Country:US
Practice Address - Phone:407-962-4447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9112666363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical