Healthcare Provider Details

I. General information

NPI: 1043877947
Provider Name (Legal Business Name): DANIELLE EVETTE STREET APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2019
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 CEDAR BROOK DR SE
CONYERS GA
30094-4506
US

IV. Provider business mailing address

4700 CEDAR BROOK DR SE
CONYERS GA
30094-4506
US

V. Phone/Fax

Practice location:
  • Phone: 561-308-1998
  • Fax:
Mailing address:
  • Phone: 561-308-1998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP715942
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN715942
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: