Provider Demographics
NPI:1417217498
Name:FIGUEROA, DANISHA GISELLE (MD)
Entity type:Individual
Prefix:
First Name:DANISHA
Middle Name:GISELLE
Last Name:FIGUEROA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 KINGSLEY AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4525
Mailing Address - Country:US
Mailing Address - Phone:904-298-2113
Mailing Address - Fax:904-298-1922
Practice Address - Street 1:1536 KINGSLEY AVE STE 118
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4525
Practice Address - Country:US
Practice Address - Phone:904-298-2113
Practice Address - Fax:904-298-1922
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18399208D00000X
FLME126154207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017918800Medicaid
FL017918800Medicaid