Provider Demographics
NPI:1912136060
Name:QUEZADA, DANIEL P (HOMEMAKER)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:P
Last Name:QUEZADA
Suffix:
Gender:M
Credentials:HOMEMAKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 SE 173RD ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-6073
Mailing Address - Country:US
Mailing Address - Phone:352-347-2361
Mailing Address - Fax:
Practice Address - Street 1:2550 SE 173RD ST
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-6073
Practice Address - Country:US
Practice Address - Phone:352-347-2361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNONE376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker