Individual
DANELLE WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ADULT NP-BC,PMHNP-BC
Contact information
Practice address
4624 PARK ST, JACKSONVILLE, FL 32205-7327
(904) 503-0131
Mailing address
5633 CLIFTON AVE, JACKSONVILLE, FL 32211-6901
(850) 896-5018
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
ARNP9227262
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
9227262
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102378500
—
FL
Enumeration date
10/30/2012
Last updated
08/26/2020
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