Provider Demographics
NPI:1578600193
Name:DANIELS, DONALD TUCKER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:TUCKER
Last Name:DANIELS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:JPHN
Other - Middle Name:EDWARD
Other - Last Name:AHRENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 666
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93581-0666
Mailing Address - Country:US
Mailing Address - Phone:661-822-9105
Mailing Address - Fax:661-822-6953
Practice Address - Street 1:20797 SANTA LUCIA ST
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-8676
Practice Address - Country:US
Practice Address - Phone:661-822-9105
Practice Address - Fax:661-822-6953
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13262363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical