Healthcare Provider Details

I. General information

NPI: 1891626669
Provider Name (Legal Business Name): DANIEL OHLIN APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 STADIUM PKWY STE 101
MELBOURNE FL
32940-8095
US

IV. Provider business mailing address

5500 STADIUM PKWY STE 101
MELBOURNE FL
32940-8095
US

V. Phone/Fax

Practice location:
  • Phone: 321-633-6439
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11047751
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: