Provider Demographics
NPI:1013298363
Name:PRENTICE, DANIEL RAY (PA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:RAY
Last Name:PRENTICE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:7301 WEST BLVD STE A1
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5268
Mailing Address - Country:US
Mailing Address - Phone:330-758-2775
Mailing Address - Fax:330-758-2787
Practice Address - Street 1:201 FOREST PARK CIR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4916
Practice Address - Country:US
Practice Address - Phone:850-248-7777
Practice Address - Fax:850-248-7779
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2021-05-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9106119363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant