Basic Information
| Provider Information | |||||||||
| NPI: | 1215400189 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NUNNELLY | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | ADAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3002 ROSEBUD LN | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335117540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133894243 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 TAMPA GENERAL CIR # A327 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336063571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138444434 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2019 | ||||||||
| LastUpdateDate: | 02/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | RN9391610 | FL | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 363LC0200X | APRN11001553 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Critical Care Medicine |
No ID Information.