MEDICARE: DANISE S LANCIAULT ARNP

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
1	101YM0800X	Mental Health Counselor	ARNP620842	FL

General Provider Information

NPI Number	:	1215986971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANISE S LANCIAULT ARNP

Provider Business Mailing Address
First Line	:	1108 HAMLET LN E
Second Line	:
City	:	NEPTUNE BEACH
State	:	FL
Zip	:	32266-3140
Country	:	US
Telephone Number	:	904-725-6463
Fax Number	:	904-724-5006

Provider Business Practice Location Address
First Line	:	1108 HAMLET LN E
Second Line	:
City	:	NEPTUNE BEACH
State	:	FL
Zip	:	32266-3140
Country	:	US
Telephone Number	:	904-725-6463
Fax Number	:	904-724-5006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	07/31/2008

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