Healthcare Provider Details

I. General information

NPI: 1508408121
Provider Name (Legal Business Name): DANIELLE LOUISE DRAB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10335 CROSS CREEK BLVD STE 20
TAMPA FL
33647-2764
US

IV. Provider business mailing address

500 HARBOUR PLACE DR APT 1109
TAMPA FL
33602-6742
US

V. Phone/Fax

Practice location:
  • Phone: 813-388-6838
  • Fax:
Mailing address:
  • Phone: 832-229-6163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP141355
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11002368
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: