Basic Information
Provider Information
NPI: 1538137872
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DANIEL
FirstName: JANICE
MiddleName: LEE
NamePrefix: MS.
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 44008
Address2: UFJP PROVIDER ENROLLMENT
City: JACKSONVILLE
State: FL
PostalCode: 322314008
CountryCode: US
TelephoneNumber: 9042443660
FaxNumber: 9042443425
Practice Location
Address1: 580 W 8TH ST
Address2: UFJP NEUROLOGY
City: JACKSONVILLE
State: FL
PostalCode: 322096533
CountryCode: US
TelephoneNumber: 9042443960
FaxNumber: 9042443425
Other Information
ProviderEnumerationDate: 03/11/2006
LastUpdateDate: 12/05/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200XARNP 1944942FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health

No ID Information.


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