Healthcare Provider Details

I. General information

NPI: 1013867795
Provider Name (Legal Business Name): DAISY MAE PILA DE LA PENA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 N CAUSEWAY SUITE C
NEW SMYRNA BEACH FL
32169-5300
US

IV. Provider business mailing address

161 N CAUSEWAY SUITE C
NEW SMYRNA BEACH FL
32169-5300
US

V. Phone/Fax

Practice location:
  • Phone: 386-424-8440
  • Fax: 386-426-8839
Mailing address:
  • Phone: 386-424-8440
  • Fax: 386-426-8839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11045175
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: