Healthcare Provider Details

I. General information

NPI: 1427818772
Provider Name (Legal Business Name): DANA ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 03/23/2024
Certification Date: 03/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 SHORT BRANCH DR STE 103
TRINITY FL
34655-4423
US

IV. Provider business mailing address

1819 SHORT BRANCH DR STE 103
TRINITY FL
34655-4423
US

V. Phone/Fax

Practice location:
  • Phone: 727-416-1272
  • Fax:
Mailing address:
  • Phone: 727-416-1272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW11670
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: