Healthcare Provider Details

I. General information

NPI: 1215986971
Provider Name (Legal Business Name): DANISE S LANCIAULT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 HAMLET LN E
NEPTUNE BEACH FL
32266-3140
US

IV. Provider business mailing address

1108 HAMLET LN E
NEPTUNE BEACH FL
32266-3140
US

V. Phone/Fax

Practice location:
  • Phone: 904-725-6463
  • Fax: 904-724-5006
Mailing address:
  • Phone: 904-725-6463
  • Fax: 904-724-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberARNP620842
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: