Basic Information
Provider Information
NPI: 1205390945
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BURFIELD
FirstName: DANIEL
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11945 SAN JOSE BLVD STE 300
Address2:  
City: JACKSONVILLE
State: FL
PostalCode: 322231627
CountryCode: US
TelephoneNumber: 9043961725
FaxNumber: 9043964893
Practice Location
Address1: 1890 LPGA BLVD STE 250
Address2:  
City: DAYTONA BEACH
State: FL
PostalCode: 321177131
CountryCode: US
TelephoneNumber: 3862740250
FaxNumber: 3862740269
Other Information
ProviderEnumerationDate: 01/28/2019
LastUpdateDate: 08/01/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPRN11000335FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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