Provider Demographics
NPI:1396289005
Name:CRAIG, CODI (PAC)
Entity type:Individual
Prefix:
First Name:CODI
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1713 US HIGHWAY 441 N
Mailing Address - Street 2:SUITE H
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-1900
Mailing Address - Country:US
Mailing Address - Phone:863-357-1510
Mailing Address - Fax:863-357-1518
Practice Address - Street 1:1713 US HIGHWAY 441 N
Practice Address - Street 2:SUITE H
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1900
Practice Address - Country:US
Practice Address - Phone:863-357-1510
Practice Address - Fax:863-357-1518
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9109812363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant