Provider Demographics
NPI:1619072329
Name:DAILEY, CHRISTY A (PA)
Entity Type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:A
Last Name:DAILEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9631 HEMINGWAY LN
Mailing Address - Street 2:UNIT 3602
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-6782
Mailing Address - Country:US
Mailing Address - Phone:850-525-8261
Mailing Address - Fax:
Practice Address - Street 1:1630 MEDICAL LN
Practice Address - Street 2:SUITE A & B
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1129
Practice Address - Country:US
Practice Address - Phone:239-278-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103849363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9103849OtherSTATE LICENSE