Provider Demographics
NPI:1003879388
Name:CANZANO, KRISTI L (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:L
Last Name:CANZANO
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 1:7572 DEER PATH
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-2880
Mailing Address - Country:US
Mailing Address - Phone:440-832-0618
Mailing Address - Fax:
Practice Address - Street 1:1999 ENTERPRISE PKWY
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2207
Practice Address - Country:US
Practice Address - Phone:330-963-5206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50000838363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S52441Medicare UPIN