Provider Demographics
NPI:1033781281
Name:BLACK, DANIELLE ERICA (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ERICA
Last Name:BLACK
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 BRIDGETOWN CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-6346
Mailing Address - Country:US
Mailing Address - Phone:336-987-2378
Mailing Address - Fax:
Practice Address - Street 1:1511 BRIDGETOWN CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-6346
Practice Address - Country:US
Practice Address - Phone:336-987-2378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily