Provider Demographics
NPI:1538905963
Name:DELGADO, THAIS (PA)
Entity type:Individual
Prefix:
First Name:THAIS
Middle Name:
Last Name:DELGADO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3507 LEE BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1303
Mailing Address - Country:US
Mailing Address - Phone:239-368-8071
Mailing Address - Fax:239-368-8074
Practice Address - Street 1:3507 LEE BLVD STE 107
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1303
Practice Address - Country:US
Practice Address - Phone:239-368-8071
Practice Address - Fax:239-368-8074
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-04
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9119144363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant