Provider Demographics
NPI:1447448113
Name:KRAYSSA, WATFA EMILE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:WATFA
Middle Name:EMILE
Last Name:KRAYSSA
Suffix:
Gender:F
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 1:2438 E COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4040
Mailing Address - Country:US
Mailing Address - Phone:954-772-6740
Mailing Address - Fax:954-772-6703
Practice Address - Street 1:2438 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4040
Practice Address - Country:US
Practice Address - Phone:954-772-6740
Practice Address - Fax:954-772-6703
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104341363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34799OtherBCBS FL
FL34799OtherBCBS FL