Provider Demographics
NPI:1932163144
Name:HAUPT, CHASIE L (PA)
Entity Type:Individual
Prefix:
First Name:CHASIE
Middle Name:L
Last Name:HAUPT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHASIE
Other - Middle Name:LYNN
Other - Last Name:HAUPT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:5220 SUMMERLIN COMMONS BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2149
Mailing Address - Country:US
Mailing Address - Phone:239-232-1180
Mailing Address - Fax:
Practice Address - Street 1:1295 JACARANDA BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-4522
Practice Address - Country:US
Practice Address - Phone:941-538-7947
Practice Address - Fax:941-484-1072
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101528363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291046200Medicaid
970021284OtherRAILROAD MEDICARE
FLE5925VOtherPTAN
970021281OtherRAILROAD MEDICARE
970021281OtherRAILROAD MEDICARE
FLE5925ZMedicare PIN
FL291046200Medicaid
P36768Medicare UPIN