Provider Demographics
NPI:1598319980
Name:GOULD, DANIELLA (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:DANIELLA
Middle Name:
Last Name:GOULD
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 GEORGE ST APT 411
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3598
Mailing Address - Country:US
Mailing Address - Phone:401-374-5397
Mailing Address - Fax:
Practice Address - Street 1:75 KINGS HIGHWAY CUTOFF OFC
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5340
Practice Address - Country:US
Practice Address - Phone:860-203-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.008318363LA2200X
CT8318363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health