Provider Demographics
NPI:1215995964
Name:CHARLES, DAPHNE R (PA-C)
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:R
Last Name:CHARLES
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 1:9973 SE 58TH AVE UNIT 104
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-9368
Mailing Address - Country:US
Mailing Address - Phone:352-693-4777
Mailing Address - Fax:
Practice Address - Street 1:9973 SE 58TH AVE UNIT 104
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-9368
Practice Address - Country:US
Practice Address - Phone:352-693-4777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103033363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLLT346OtherPTAN