Healthcare Provider Details

I. General information

NPI: 1669920880
Provider Name (Legal Business Name): DANIEL V MOCK MSN, APRN, AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W 20TH AVE STE G176
HIALEAH FL
33016-1875
US

IV. Provider business mailing address

15954 SW 4TH ST
PEMBROKE PINES FL
33027-1156
US

V. Phone/Fax

Practice location:
  • Phone: 786-475-1985
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP9311528
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberARNP9311528
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: