Provider Demographics
NPI:1720794613
Name:GODFREY, DANIELLE (RN,MSN,RNC-MNN,IBCLC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:GODFREY
Suffix:
Gender:
Credentials:RN,MSN,RNC-MNN,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 COUNTRYSIDE WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-7988
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3510 S NOVA RD STE 111
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-3796
Practice Address - Country:US
Practice Address - Phone:386-310-9401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9565465163WM0102X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal NewbornGroup - Single Specialty