Healthcare Provider Details

I. General information

NPI: 1144359340
Provider Name (Legal Business Name): DANIELLE NICOLE JONES-MONTALVO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 SAXON BLVD
ORANGE CITY FL
32763-8468
US

IV. Provider business mailing address

852 COUNTS CREST CIR
APOPKA FL
32712-4445
US

V. Phone/Fax

Practice location:
  • Phone: 386-917-5107
  • Fax:
Mailing address:
  • Phone: 484-357-7646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA002779-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: