Healthcare Provider Details

I. General information

NPI: 1619690823
Provider Name (Legal Business Name): DARYL NOEL OTINIANO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8763 RIVER CROSSING BLVD
TRINITY FL
34655-1112
US

IV. Provider business mailing address

8763 RIVER CROSSING BLVD
TRINITY FL
34655-1112
US

V. Phone/Fax

Practice location:
  • Phone: 727-846-7000
  • Fax:
Mailing address:
  • Phone: 727-846-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number11021948
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: