Provider Demographics
NPI:1962850081
Name:FAUSTINO, DANREB
Entity Type:Individual
Prefix:
First Name:DANREB
Middle Name:
Last Name:FAUSTINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 FANG DR BLDG 3
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-7933
Mailing Address - Country:US
Mailing Address - Phone:904-741-7652
Mailing Address - Fax:
Practice Address - Street 1:14300 FANG DR BLDG 3
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-7933
Practice Address - Country:US
Practice Address - Phone:904-741-7652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9375930163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse