Provider Demographics
NPI:1528517554
Name:BORRELLI, KRISTINA ANNE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:ANNE
Last Name:BORRELLI
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 1:31 SCHOOSETT ST STE 202
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-1886
Mailing Address - Country:US
Mailing Address - Phone:781-924-5173
Mailing Address - Fax:
Practice Address - Street 1:31 SCHOOSETT ST STE 202
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-1886
Practice Address - Country:US
Practice Address - Phone:781-924-5173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5926363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant