Provider Demographics
NPI:1508842196
Name:DANIEL, JANE AILENE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:AILENE
Last Name:DANIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 COLONIAL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1031
Mailing Address - Country:US
Mailing Address - Phone:239-939-2229
Mailing Address - Fax:239-939-0399
Practice Address - Street 1:1570 COLONIAL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1031
Practice Address - Country:US
Practice Address - Phone:239-939-2229
Practice Address - Fax:239-939-0399
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62545207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE94025Medicare UPIN
FL26379Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER