Individual
DAPHNE R CHARLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9973 SE 58TH AVE UNIT 104, BELLEVIEW, FL 34420-9368
(352) 693-4777
Mailing address
9973 SE 58TH AVE UNIT 104, BELLEVIEW, FL 34420-9368
(352) 693-4777
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9103033
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LT346
PTAN
FL
Enumeration date
05/03/2006
Last updated
07/26/2024
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