Provider Demographics
NPI:1194852095
Name:DANIELS, ANITRA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ANITRA
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:ANITRA
Other - Middle Name:GENEA
Other - Last Name:AYTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:8788 ELK GROVE BLVD STE 2B
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1766
Mailing Address - Country:US
Mailing Address - Phone:559-302-7957
Mailing Address - Fax:
Practice Address - Street 1:8788 ELK GROVE BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1766
Practice Address - Country:US
Practice Address - Phone:916-602-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13956363LF0000X
CANP 13956363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily