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General NPI Number Information
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NPI Number | 1023613247
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Entity Type | Individual
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Provider Name | LAVONTE MCDANIEL FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/04/2020
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Last Update Date | 05/05/2023
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Provider Practice Location Address
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Address Line | 225 SW SUMATRA AVE
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City | MADISON
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State | FL
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Zip | 32340-1454
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Country | US
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Telephone | 850-973-5124
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Fax | 850-973-5128
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Provider Business Mailing Address
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Address Line | 264 SE MANDARIN WAY
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City | LEE
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State | FL
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Zip | 32059-4744
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Country | US
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Telephone | 850-464-0949
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11009950
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License Number State | FL
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