Provider Demographics
NPI:1033464441
Name:DANIELS, CORI MEGAN (NP)
Entity type:Individual
Prefix:MRS
First Name:CORI
Middle Name:MEGAN
Last Name:DANIELS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:CORI
Other - Middle Name:MEGAN
Other - Last Name:BARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2409 WILLOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4142
Mailing Address - Country:US
Mailing Address - Phone:321-863-8215
Mailing Address - Fax:
Practice Address - Street 1:2409 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4142
Practice Address - Country:US
Practice Address - Phone:321-863-8215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9253387363L00000X
IAA158720363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner