Provider Demographics
NPI:1962947283
Name:MCDANIEL, VANESSA MARIE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:MARIE
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 PARK SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-2016
Mailing Address - Country:US
Mailing Address - Phone:817-807-9060
Mailing Address - Fax:817-419-4505
Practice Address - Street 1:4401 PARK SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-2016
Practice Address - Country:US
Practice Address - Phone:817-807-9060
Practice Address - Fax:817-419-4505
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX818467363LF0000X
TXAP132390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily