Healthcare Provider Details

I. General information

NPI: 1255194619
Provider Name (Legal Business Name): IRINA DANILOVA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 INTERSTATE BLVD UNIT C
SARASOTA FL
34240-8926
US

IV. Provider business mailing address

405 INTERSTATE BLVD UNIT C
SARASOTA FL
34240-8926
US

V. Phone/Fax

Practice location:
  • Phone: 941-312-1633
  • Fax: 941-732-1658
Mailing address:
  • Phone: 941-312-1633
  • Fax: 941-732-1658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN266009
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11031033
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: