Healthcare Provider Details

I. General information

NPI: 1306766555
Provider Name (Legal Business Name): DANIELLE TABAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8770 NW 37TH DR
CORAL SPRINGS FL
33065-3047
US

IV. Provider business mailing address

8770 NW 37TH DR
CORAL SPRINGS FL
33065-3047
US

V. Phone/Fax

Practice location:
  • Phone: 949-878-6639
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11049219
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: