Provider Demographics
NPI:1366149957
Name:KIDD, DANYALE LATRICE (APRN)
Entity type:Individual
Prefix:
First Name:DANYALE
Middle Name:LATRICE
Last Name:KIDD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DANYALE
Other - Middle Name:LATRICE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8333 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6050
Mailing Address - Country:US
Mailing Address - Phone:850-474-8200
Mailing Address - Fax:850-474-8016
Practice Address - Street 1:8333 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6050
Practice Address - Country:US
Practice Address - Phone:850-474-8200
Practice Address - Fax:850-474-8016
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11024351363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty