Healthcare Provider Details

I. General information

NPI: 1477807444
Provider Name (Legal Business Name): DANELLE WEAVER ADULT NP-BC,PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE WEAVER

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4624 PARK ST
JACKSONVILLE FL
32205-7327
US

IV. Provider business mailing address

5633 CLIFTON AVE
JACKSONVILLE FL
32211-6901
US

V. Phone/Fax

Practice location:
  • Phone: 904-503-0131
  • Fax:
Mailing address:
  • Phone: 850-896-5018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9227262
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number9227262
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: