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General NPI Number Information
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NPI Number | 1932163144
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Entity Type | Individual
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Provider Name | CHASIE L. HAUPT PA
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Gender | Female
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Dates
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Enumeration Date | 04/14/2006
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 1295 JACARANDA BLVD
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City | VENICE
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State | FL
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Zip | 34292-4522
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Country | US
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Telephone | 941-538-7947
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Fax | 941-484-1072
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Provider Business Mailing Address
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Address Line | 5220 SUMMERLIN COMMONS BLVD FL 4
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City | FORT MYERS
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State | FL
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Zip | 33907-2149
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Country | US
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Telephone | 239-232-1180
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9101528
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License Number State | FL
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