Provider Demographics
NPI:1891326450
Name:KANTANKA, DANIEL SAFO (FNP)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:SAFO
Last Name:KANTANKA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 B ST APT 211
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-7110
Mailing Address - Country:US
Mailing Address - Phone:240-505-2699
Mailing Address - Fax:
Practice Address - Street 1:10801 LOCKWOOD DR STE 160
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1586
Practice Address - Country:US
Practice Address - Phone:240-545-5721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR243013363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily