1881667004 NPI number — MRS. DANIELLE JEAN STOOK FNP-C

Table of content: MRS. DANIELLE JEAN STOOK FNP-C (NPI 1881667004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881667004 NPI number — MRS. DANIELLE JEAN STOOK FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOOK
Provider First Name:
DANIELLE
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COWLES
Provider Other First Name:
DANIELLE
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881667004
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1395 S STATE ROAD 7
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
WELLINGTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33414-9325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-795-2878
Provider Business Mailing Address Fax Number:
561-795-0464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1395 S STATE ROAD 7
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33414-9325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-795-2878
Provider Business Practice Location Address Fax Number:
561-795-0464
Provider Enumeration Date:
02/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP30007184 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: ARNP9435208 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0039573 . This is a "LABOR AND INDUSTRIES #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: NP573WA , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00393171 . This is a "RAILROAD MC #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9652637 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3273CO . This is a "BLUE SHIELD #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: US7503941 . This is a "AETNA PCP PIN #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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