Provider Demographics
NPI:1326473109
Name:DAUG, CHARLOTTE SOFIA JANE (FNP)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:SOFIA JANE
Last Name:DAUG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:DAUG
Other - Last Name:GONZAGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:71-511 HIGHWAY 111
Mailing Address - Street 2:SUITE H
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:602-799-6120
Mailing Address - Fax:
Practice Address - Street 1:71-511 HIGHWAY 111
Practice Address - Street 2:SUITE H
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-773-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23023363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner