Provider Demographics
NPI:1972202141
Name:BARNES, DANVANILLA Q (MD)
Entity Type:Individual
Prefix:DR
First Name:DANVANILLA
Middle Name:Q
Last Name:BARNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DANVANILLA
Other - Middle Name:Q
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3117
Mailing Address - Street 2:33440
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440
Mailing Address - Country:US
Mailing Address - Phone:863-677-5150
Mailing Address - Fax:
Practice Address - Street 1:400 S BERNER RD # 33440
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3408
Practice Address - Country:US
Practice Address - Phone:863-677-5150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X, 172A00000X, 173000000X, 174200000X, 176B00000X, 103TR0400X
FL2036638152WP0200X, 207VC0300X
FL573289176P00000X, 207PS0010X, 207QH0002X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No172A00000XOther Service ProvidersDriver
No173000000XOther Service ProvidersLegal Medicine
No174200000XOther Service ProvidersMeals
No176B00000XOther Service ProvidersMidwife
No176P00000XOther Service ProvidersFuneral Director
No207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VC0300XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyComplex Family Planning
Provider Identifiers
StateIdentifier IDID TypeIssuer
BLUECROSSOtherBLUE CROSS
FLHMOOtherHMO
FLMEDICAREOtherMEDICARE