Provider Demographics
NPI:1265080204
Name:LONSWAY, DANIELLE TELHIARD (PA-C)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:TELHIARD
Last Name:LONSWAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10743 NARCOOSSEE RD STE A18
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6947
Mailing Address - Country:US
Mailing Address - Phone:407-277-1900
Mailing Address - Fax:
Practice Address - Street 1:10743 NARCOOSSEE RD STE A18
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6947
Practice Address - Country:US
Practice Address - Phone:407-277-1900
Practice Address - Fax:407-277-1888
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112572363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty