Individual
STACEY DANIELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
183 SE COLUMBUS TRL, MADISON, FL 32340-3100
(850) 464-9617
Mailing address
183 SE COLUMBUS TRL, MADISON, FL 32340-3100
(850) 464-9617
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL13219
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100933600
—
FL
Enumeration date
12/20/2019
Last updated
12/20/2019
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