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NPI Code Detail

MEDICARE: DANIEL DANIELS PA

MEDICARE: DANIEL DANIELS PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA9102480FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134121445
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL DANIELS PA
Provider Business Mailing Address
First Line : PO BOX 30731
Second Line :
City : TAMPA
State : FL
Zip : 33630-3731
Country : US
Telephone Number : 800-476-8646
Fax Number : 919-382-3210
Provider Business Practice Location Address
First Line : 110 LONGWOOD AVE
Second Line :
City : ROCKLEDGE
State : FL
Zip : 32955-2828
Country : US
Telephone Number : 800-476-8646
Fax Number : 919-382-3210
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 08/04/2010

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