Healthcare Provider Details

I. General information

NPI: 1942967880
Provider Name (Legal Business Name): THOMAS A DANIELS AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2021
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7552 HOSPITAL DR
GLOUCESTER VA
23061-4178
US

IV. Provider business mailing address

7552 HOSPITAL DR
GLOUCESTER VA
23061-4178
US

V. Phone/Fax

Practice location:
  • Phone: 804-693-9062
  • Fax:
Mailing address:
  • Phone: 804-693-9062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0001282142
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: