Provider Demographics
NPI:1609550953
Name:DUFFEY, CHRISTAL JADE (PA)
Entity type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:JADE
Last Name:DUFFEY
Suffix:
Gender:
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33836-0878
Mailing Address - Country:US
Mailing Address - Phone:689-223-3898
Mailing Address - Fax:689-223-3898
Practice Address - Street 1:515 E GARDEN ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4615
Practice Address - Country:US
Practice Address - Phone:863-683-5454
Practice Address - Fax:863-683-4652
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2025-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9117528363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical