Provider Demographics
NPI:1437607702
Name:DRISCOLL, DANIELLE (CRDH, MHS)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:CRDH, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 ELYSIUM BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-7065
Mailing Address - Country:US
Mailing Address - Phone:352-552-1439
Mailing Address - Fax:
Practice Address - Street 1:1017 ELYSIUM BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-7065
Practice Address - Country:US
Practice Address - Phone:352-552-1439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH11132124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL124Q00000XMedicaid