Provider Demographics
NPI:1083060636
Name:GALLEY, DALIA AZUOLAITYTE (PNP)
Entity Type:Individual
Prefix:MRS
First Name:DALIA
Middle Name:AZUOLAITYTE
Last Name:GALLEY
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2473 CORONADO WAY
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-2015
Mailing Address - Country:US
Mailing Address - Phone:708-655-3520
Mailing Address - Fax:
Practice Address - Street 1:3838 W NEPTUNE ST STE D6
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5841
Practice Address - Country:US
Practice Address - Phone:813-254-4209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9325551363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics