Provider Demographics
NPI:1215529672
Name:CONLON, DANIELLE RENEE (FNP-C)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RENEE
Last Name:CONLON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15460 ROCKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:POLK CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33868-7640
Mailing Address - Country:US
Mailing Address - Phone:330-605-0235
Mailing Address - Fax:
Practice Address - Street 1:15460 ROCKRIDGE RD
Practice Address - Street 2:
Practice Address - City:POLK CITY
Practice Address - State:FL
Practice Address - Zip Code:33868-7640
Practice Address - Country:US
Practice Address - Phone:330-605-0235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011492363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily