Provider Demographics
NPI:1306597414
Name:CARBALLO, DAPHNE (PA-C)
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:
Last Name:CARBALLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-4252
Mailing Address - Country:US
Mailing Address - Phone:786-512-4050
Mailing Address - Fax:
Practice Address - Street 1:680 2ND AVE N STE 304
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5757
Practice Address - Country:US
Practice Address - Phone:239-206-2833
Practice Address - Fax:855-395-9156
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61190261363AM0700X
FL9120695363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant