Healthcare Provider Details

I. General information

NPI: 1376063552
Provider Name (Legal Business Name): DANIELLE LEE COOK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEMORIAL MEDICAL PKWY STE 201
PALM COAST FL
32164-5979
US

IV. Provider business mailing address

1 MEMORIAL MEDICAL PKWY
PALM COAST FL
32164-5979
US

V. Phone/Fax

Practice location:
  • Phone: 386-445-4750
  • Fax:
Mailing address:
  • Phone: 386-445-4750
  • Fax: 352-732-0490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9367271
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: