Provider Demographics
NPI:1508408121
Name:DRAB, DANIELLE LOUISE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LOUISE
Last Name:DRAB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 HARBOUR PLACE DR APT 1109
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-6742
Mailing Address - Country:US
Mailing Address - Phone:832-229-6163
Mailing Address - Fax:
Practice Address - Street 1:10335 CROSS CREEK BLVD STE 20
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2764
Practice Address - Country:US
Practice Address - Phone:813-388-6838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141355363LF0000X
FLAPRN11002368363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily