Individual
BRANNAN DANIELLE MALICOAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1111 RONALD REAGAN PKWY STE 1100, AVON, IN 46123-7085
(317) 944-7874
(317) 968-1067
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71008706A
IN
363LF0000X
Family Nurse Practitioner
F10181240
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
233690179
MEDICARE PTAN
IN
05
—
300040824
—
IN
01
—
677730052
MEDICARE
IN
Enumeration date
12/23/2018
Last updated
11/05/2025
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