Provider Demographics
NPI:1619072311
Name:DAUGHTRY, CHAR LYNN (LM, CPM)
Entity Type:Individual
Prefix:
First Name:CHAR
Middle Name:LYNN
Last Name:DAUGHTRY
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 PALM IS NW
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33767-1934
Mailing Address - Country:US
Mailing Address - Phone:727-446-4532
Mailing Address - Fax:727-442-7834
Practice Address - Street 1:990 BROADWAY
Practice Address - Street 2:SUITE C
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5763
Practice Address - Country:US
Practice Address - Phone:727-734-2229
Practice Address - Fax:727-734-8855
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW#1176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife