Provider Demographics
NPI:1902891203
Name:JIANNETTO, DANIEL FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:FRANK
Last Name:JIANNETTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 REGIONS WAY
Mailing Address - Street 2:BLDG 1 SUITE D
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-5106
Mailing Address - Country:US
Mailing Address - Phone:850-650-7560
Mailing Address - Fax:850-650-7562
Practice Address - Street 1:151 REGIONS WAY
Practice Address - Street 2:BLDG 1 STE D
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-5106
Practice Address - Country:US
Practice Address - Phone:850-650-7560
Practice Address - Fax:850-650-7562
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81509174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG27456Medicare UPIN