Provider Demographics
NPI:1124221767
Name:NELSON, DANIELLE SUSANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:SUSANNE
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:SUSANNE
Other - Last Name:KAUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1707 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-3650
Mailing Address - Country:US
Mailing Address - Phone:352-265-7001
Mailing Address - Fax:352-265-9584
Practice Address - Street 1:1707 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-3650
Practice Address - Country:US
Practice Address - Phone:352-265-7001
Practice Address - Fax:352-265-9584
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106223207Q00000X
FLME129181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018830500Medicaid
FLIT125ZMedicare PIN