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General NPI Number Information
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NPI Number | 1306597414
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Entity Type | Individual
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Provider Name | DAPHNE CARBALLO PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/11/2022
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 680 2ND AVE N STE 304
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City | NAPLES
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State | FL
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Zip | 34102-5757
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Country | US
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Telephone | 239-206-2833
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Fax | 855-395-9156
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Provider Business Mailing Address
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Address Line | 1171 MOCKINGBIRD LN
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City | NAPLES
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State | FL
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Zip | 34104-4252
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Country | US
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Telephone | 786-512-4050
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA61190261
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9120695
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License Number State | FL
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