Sandra D Daniel, P.N.P.

Key facts

NPI

1679615413

Entity type

Individual (NPI type 1)

Primary specialty

Pediatric Nurse Practitioner 363LP0200X

License

RN042208 (GA)

Practice address

72 South Broad
Ellaville, GA 31806

Phone

(229) 937-5321

Fax

(229) 937-2232

NPI assigned

Feb 12, 2007

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679615413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 SOUTH BROAD",
            "city": "ELLAVILLE",
            "state": "GA",
            "postal_code": "31806",
            "telephone_number": "229-937-5321",
            "fax_number": "229-937-2232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 SOUTH BROAD",
            "city": "ELLAVILLE",
            "state": "GA",
            "postal_code": "31806",
            "telephone_number": "229-937-5321",
            "fax_number": "229-937-2232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANIEL",
        "first_name": "SANDRA",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "credential": "P.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "GA",
            "license": "RN042208",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00000019F",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Ellaville, GA · Pediatric Nurse Practitioner in Georgia