=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376098301
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL NAILOR CRNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2016
-----------------------------------------------------
Last Update Date | 01/26/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 339 WALKER CHAPEL PLZ #115
-----------------------------------------------------
City | FULTONDALE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35068-3401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-340-5712
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3110 GRAND AVE APT 1228
-----------------------------------------------------
City | PINELLAS PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33782-6155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1-116367
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------