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General NPI Number Information
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NPI Number | 1952637530
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Entity Type | Individual
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Provider Name | ELIZABETH M DAQUILA M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/02/2009
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 851 DUNLAWTON AVE STE 102
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City | PORT ORANGE
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State | FL
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Zip | 32127-4234
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Country | US
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Telephone | 386-402-7827
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Fax | 386-410-5457
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Provider Business Mailing Address
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Address Line | 851 DUNLAWTON AVE STE 102
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City | PORT ORANGE
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State | FL
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Zip | 32127-4234
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Country | US
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Telephone | 386-236-9328
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Fax | 386-492-2586
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35.094470
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License Number State | OH
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