Healthcare Provider Details

I. General information

NPI: 1023739539
Provider Name (Legal Business Name): EMILY H DAQUIOAG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 HOSPITAL ST STE 106
PASCAGOULA MS
39581-5306
US

IV. Provider business mailing address

2101 HIGHWAY 90
GAUTIER MS
39553-5340
US

V. Phone/Fax

Practice location:
  • Phone: 228-809-5380
  • Fax: 228-809-5386
Mailing address:
  • Phone: 228-497-7576
  • Fax: 228-497-8869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00892
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: