Provider Demographics
NPI:1194458406
Name:DALEY, NANCY JOHNSON (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:JOHNSON
Last Name:DALEY
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 N HABANA AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7152
Mailing Address - Country:US
Mailing Address - Phone:813-304-1299
Mailing Address - Fax:
Practice Address - Street 1:4710 N HABANA AVE STE 402
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7152
Practice Address - Country:US
Practice Address - Phone:813-304-1299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020599363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF06221368OtherAANPCB
FL11020599OtherFLORIDA DEPARTMENT OF NURSING