Provider Demographics
NPI:1154056018
Name:BRUNSON, DANIELLE ALEXIS (DNP APRN FNP-BC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ALEXIS
Last Name:BRUNSON
Suffix:
Gender:F
Credentials:DNP APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W MACCLENNY AVE
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-2029
Mailing Address - Country:US
Mailing Address - Phone:904-259-6380
Mailing Address - Fax:
Practice Address - Street 1:1747 BAPTIST CLAY DR STE 230
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8505
Practice Address - Country:US
Practice Address - Phone:904-592-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-23
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11019555363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily