Provider Demographics
NPI:1952637530
Name:DAQUILA, ELIZABETH M (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:DAQUILA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:851 DUNLAWTON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4234
Mailing Address - Country:US
Mailing Address - Phone:386-236-9328
Mailing Address - Fax:386-492-2586
Practice Address - Street 1:851 DUNLAWTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4234
Practice Address - Country:US
Practice Address - Phone:386-402-7827
Practice Address - Fax:386-410-5457
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.094470207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3000344Medicaid
OH4281881Medicare PIN