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General NPI Number Information
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NPI Number | 1710491386
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Entity Type | Individual
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Provider Name | DANIKA CLAIRE CORNELIUS PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/19/2017
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 17393 MISSOURI RD
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City | FORT MYERS
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State | FL
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Zip | 33967-2832
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Country | US
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Telephone | 239-293-4749
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Fax |
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Provider Business Mailing Address
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Address Line | 6413 JENNY DR
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City | LAKE WALES
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State | FL
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Zip | 33898-8919
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Country | US
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Telephone | 863-330-3136
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Fax | 863-368-8008
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9110803
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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