Provider Demographics
NPI:1417743642
Name:CALVILLO, DANIEL (FNP-BC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:CALVILLO
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 N 1120 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-1045
Mailing Address - Country:US
Mailing Address - Phone:385-235-8422
Mailing Address - Fax:801-723-3106
Practice Address - Street 1:1924 N 1120 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1045
Practice Address - Country:US
Practice Address - Phone:385-235-8422
Practice Address - Fax:801-723-3106
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11817183-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty