Provider Demographics
NPI:1245999770
Name:MCDANIEL, JOSHUA (PA)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14227 TURKEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-8134
Mailing Address - Country:US
Mailing Address - Phone:850-566-7456
Mailing Address - Fax:
Practice Address - Street 1:1514 NIRA ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8652
Practice Address - Country:US
Practice Address - Phone:904-387-4991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant