Provider Demographics
NPI:1114365525
Name:BENTON, DANIELLE NICHOLE (ASN, RN)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:NICHOLE
Last Name:BENTON
Suffix:
Gender:F
Credentials:ASN, RN
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:BENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASN, RN
Mailing Address - Street 1:405 DANUBE WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-5313
Mailing Address - Country:US
Mailing Address - Phone:419-481-2010
Mailing Address - Fax:
Practice Address - Street 1:405 DANUBE WAY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-5313
Practice Address - Country:US
Practice Address - Phone:419-481-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9646809163W00000X
376K00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Yes163W00000XNursing Service ProvidersRegistered Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide