Healthcare Provider Details

I. General information

NPI: 1063111326
Provider Name (Legal Business Name): DANIEL E. POWERS PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-2733
US

IV. Provider business mailing address

45 FOXHALL LN
PALM COAST FL
32137-4416
US

V. Phone/Fax

Practice location:
  • Phone: 386-676-7175
  • Fax:
Mailing address:
  • Phone: 229-221-7498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11023936
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: