Provider Demographics
NPI:1508211921
Name:COUCH, DANIEL (NP)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:COUCH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 W QUEEN CREEK RD APT 1021
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-3208
Mailing Address - Country:US
Mailing Address - Phone:256-572-2006
Mailing Address - Fax:
Practice Address - Street 1:7227 E BASELINE RD STE 126
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-5006
Practice Address - Country:US
Practice Address - Phone:480-868-9650
Practice Address - Fax:480-834-3606
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ258294363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology