Provider Demographics
NPI:1982052429
Name:COLEMAN, DANIELLE JACOLE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:JACOLE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:JACOLE
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3324 RIDGE BROOK TRL
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6892
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2150 PEACHFORD RD STE N
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338
Practice Address - Country:US
Practice Address - Phone:678-205-4322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR220962363LF0000X
GARN203602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily