Provider Demographics
NPI:1578000840
Name:ALTMAN, DANIELLE ANN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ANN
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 EAST CHEVES STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2616
Mailing Address - Country:US
Mailing Address - Phone:843-665-0102
Mailing Address - Fax:
Practice Address - Street 1:755 E SMITH ST
Practice Address - Street 2:
Practice Address - City:TIMMONSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29161-9430
Practice Address - Country:US
Practice Address - Phone:843-346-3900
Practice Address - Fax:843-346-7839
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20709363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4567Medicaid