Provider Demographics
NPI:1629691308
Name:DANIELS, JOHANA (APRN)
Entity Type:Individual
Prefix:
First Name:JOHANA
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 ADMIRAL HALSEY AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32124-3614
Mailing Address - Country:US
Mailing Address - Phone:386-631-5345
Mailing Address - Fax:
Practice Address - Street 1:1437 ADMIRAL HALSEY AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32124-3614
Practice Address - Country:US
Practice Address - Phone:386-631-5345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005958363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily