Provider Demographics
NPI:1114972494
Name:DAUGHTRY, NEALA M (RN)
Entity Type:Individual
Prefix:
First Name:NEALA
Middle Name:M
Last Name:DAUGHTRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5192 BAYOU BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2102
Mailing Address - Country:US
Mailing Address - Phone:850-484-5040
Mailing Address - Fax:850-475-5527
Practice Address - Street 1:5192 BAYOU BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2102
Practice Address - Country:US
Practice Address - Phone:850-484-5040
Practice Address - Fax:850-475-5527
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2156782163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN2156782OtherNURSING LICENSE NUMBER