Individual
MRS. DANIELLE NICOLE JIVIDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9981 S HEALTHPARK DR, FORT MYERS, FL 33908-3618
(239) 343-2052
(239) 343-5848
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-2052
(239) 343-5848
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9115006
FL
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114926700
—
FL
Enumeration date
09/20/2021
Last updated
06/05/2024
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