Healthcare Provider Details

I. General information

NPI: 1114890571
Provider Name (Legal Business Name): DANIELA GRACIANO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 S OAK AVE STE 7
SAN LUIS AZ
85336-0756
US

IV. Provider business mailing address

PO BOX 617
SOMERTON AZ
85350-0617
US

V. Phone/Fax

Practice location:
  • Phone: 928-366-5166
  • Fax: 928-366-5165
Mailing address:
  • Phone: 928-662-0406
  • Fax: 928-662-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number323941
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: