Provider Demographics
NPI:1093115057
Name:BATAILLE, DANIELA (PA)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:BATAILLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DANIELA
Other - Middle Name:
Other - Last Name:SHVETSOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3301 W GANDY BLVD STE E210
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-2931
Mailing Address - Country:US
Mailing Address - Phone:813-925-1903
Mailing Address - Fax:860-242-1464
Practice Address - Street 1:3301 W GANDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-2931
Practice Address - Country:US
Practice Address - Phone:813-925-1903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3166363A00000X
FLPA9113731363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003166OtherSTATE LICENSE
FLPA9113731OtherSTATE LICENSE