Provider Demographics
NPI:1962891499
Name:JOHNSTON, KRISTIAN WILLIAMS (PA)
Entity type:Individual
Prefix:MRS
First Name:KRISTIAN
Middle Name:WILLIAMS
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KRISTIAN
Other - Middle Name:DELANIE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7421 N. UNIVERSITY DRIVE
Mailing Address - Street 2:S. 307
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321
Mailing Address - Country:US
Mailing Address - Phone:954-720-7272
Mailing Address - Fax:
Practice Address - Street 1:7421 N. UNIVERSITY DRIVE
Practice Address - Street 2:S. 307
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321
Practice Address - Country:US
Practice Address - Phone:954-720-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108516363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant