Healthcare Provider Details

I. General information

NPI: 1245999770
Provider Name (Legal Business Name): JOSHUA MCDANIEL PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 NIRA ST
JACKSONVILLE FL
32207-8652
US

IV. Provider business mailing address

14227 TURKEY CREEK DR
TALLAHASSEE FL
32312-8134
US

V. Phone/Fax

Practice location:
  • Phone: 904-387-4991
  • Fax:
Mailing address:
  • Phone: 850-566-7456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: