Healthcare Provider Details

I. General information

NPI: 1548825466
Provider Name (Legal Business Name): MATTHEW DANNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 W MILLER ST
ORLANDO FL
32806-2031
US

IV. Provider business mailing address

2135 ARROWHEAD LN
CHULUOTA FL
32766-8655
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-9792
  • Fax:
Mailing address:
  • Phone: 407-765-6288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN9349663
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: