Provider Demographics
NPI:1215483508
Name:COBB, DANITA
Entity type:Individual
Prefix:
First Name:DANITA
Middle Name:
Last Name:COBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 SOUTH ORANGE BLOSSOM TRAIL. SUITE 236
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805
Mailing Address - Country:US
Mailing Address - Phone:407-717-4164
Mailing Address - Fax:407-205-1128
Practice Address - Street 1:750 S ORANGE BLOSSOM TRL STE 236
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-3196
Practice Address - Country:US
Practice Address - Phone:407-717-4164
Practice Address - Fax:407-205-1128
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator