Healthcare Provider Details

I. General information

NPI: 1972202141
Provider Name (Legal Business Name): DANVANILLA Q BARNES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANVANILLA Q BARNES MD

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S BERNER RD # 33440
CLEWISTON FL
33440-3408
US

IV. Provider business mailing address

PO BOX 3117 33440
CLEWISTON FL
33440
US

V. Phone/Fax

Practice location:
  • Phone: 863-677-5150
  • Fax:
Mailing address:
  • Phone: 863-677-5150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number2036638
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code176P00000X
TaxonomyFuneral Director
License Number573289
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number573289
License Number StateFL
# 9
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 10
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number573289
License Number StateFL
# 11
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number573289
License Number StateFL
# 12
Primary TaxonomyN
Taxonomy Code207VC0300X
TaxonomyComplex Family Planning Physician
License Number2036638
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: