Provider Demographics
NPI:1235307596
Name:BACIU, DANIELA (PA, MHS)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:BACIU
Suffix:
Gender:F
Credentials:PA, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 LINTON BLVD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6542
Mailing Address - Country:US
Mailing Address - Phone:561-499-0660
Mailing Address - Fax:561-499-4094
Practice Address - Street 1:5210 LINTON BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6542
Practice Address - Country:US
Practice Address - Phone:561-499-0660
Practice Address - Fax:561-499-4094
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9102517363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5524YMedicare PIN