Provider Demographics
NPI:1013510080
Name:DANIEL, REBECCA JOAN (AGACNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JOAN
Last Name:DANIEL
Suffix:
Gender:
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6751 HIGHLAND POINTE PL
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30656-6228
Mailing Address - Country:US
Mailing Address - Phone:770-356-9979
Mailing Address - Fax:
Practice Address - Street 1:6751 HIGHLAND POINTE PL
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30656-6228
Practice Address - Country:US
Practice Address - Phone:770-356-9979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN27497163WE0003X
GARN227497363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No163WE0003XNursing Service ProvidersRegistered NurseEmergency