Healthcare Provider Details

I. General information

NPI: 1538541321
Provider Name (Legal Business Name): DANIEL KWAMENA KORSAH ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 BOULEVARD 5TH FLOOR
JACKSONVILLE FL
32206-4382
US

IV. Provider business mailing address

3667 MIDDLEBROOK DR
ORANGE PARK FL
32065-5543
US

V. Phone/Fax

Practice location:
  • Phone: 904-383-1040
  • Fax:
Mailing address:
  • Phone: 904-521-3608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9325340
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: