Provider Demographics
NPI:1598012791
Name:GLAZER, DANIELLE MIDDLE (FNP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MIDDLE
Last Name:GLAZER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:LATTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46896 HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:BIG SUR
Mailing Address - State:CA
Mailing Address - Zip Code:93920-9693
Mailing Address - Country:US
Mailing Address - Phone:831-667-2580
Mailing Address - Fax:831-667-0184
Practice Address - Street 1:46896 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:BIG SUR
Practice Address - State:CA
Practice Address - Zip Code:93920-9693
Practice Address - Country:US
Practice Address - Phone:831-667-2580
Practice Address - Fax:831-667-0184
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22158363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care