Healthcare Provider Details

I. General information

NPI: 1619072311
Provider Name (Legal Business Name): CHAR LYNN DAUGHTRY L.M., C.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 BROADWAY SUITE C
DUNEDIN FL
34698-5763
US

IV. Provider business mailing address

210 PALM IS NW
CLEARWATER BEACH FL
33767-1934
US

V. Phone/Fax

Practice location:
  • Phone: 727-734-2229
  • Fax: 727-734-8855
Mailing address:
  • Phone: 727-446-4532
  • Fax: 727-442-7834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW#1
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: