Provider Demographics
NPI:1861961989
Name:DANIELS, ETOYUS (APRN)
Entity type:Individual
Prefix:
First Name:ETOYUS
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ANN CT
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-6705
Mailing Address - Country:US
Mailing Address - Phone:404-451-4052
Mailing Address - Fax:
Practice Address - Street 1:1360 DOGWOOD DR SE STE 104
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-5077
Practice Address - Country:US
Practice Address - Phone:404-793-8210
Practice Address - Fax:404-793-8375
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN226360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty