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General NPI Number Information
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NPI Number | 1144778457
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Entity Type | Individual
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Provider Name | KY DAU PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/15/2016
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Last Update Date | 05/08/2019
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Provider Practice Location Address
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Address Line | 5332 VAN DYKE RD
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City | LUTZ
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State | FL
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Zip | 33558-4829
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Country | US
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Telephone | 813-960-1200
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Fax | 813-441-7555
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Provider Business Mailing Address
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Address Line | 5332 VAN DYKE RD
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City | LUTZ
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State | FL
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Zip | 33558-4829
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Country | US
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Telephone | 813-960-1200
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Fax | 813-441-7555
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9109120
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License Number State | FL
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