Individual
DEE A SHEETS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
22395 EDGEWATER DR, PORT CHARLOTTE, FL 33980-2012
(941) 766-7222
(941) 766-0970
Mailing address
PO BOX 102222, ATLANTA, GA 30368-2222
(239) 274-8200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9105411
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105997900
—
FL
Enumeration date
12/23/2010
Last updated
12/30/2025
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