Individual
MRS. DANIELLE FAY THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
118 W FAIRBANKS AVE, WINTER PARK, FL 32789-4327
(407) 646-2235
Mailing address
118 W FAIRBANKS AVE, WINTER PARK, FL 32789-4327
(407) 646-2235
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9105684
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA 9105684
FLORIDA STATE LICENSE
FL
Enumeration date
01/13/2011
Last updated
04/29/2013
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