Provider Demographics
NPI:1083084701
Name:NUGENT, DANIELLE (CRNP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:NUGENT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:CIVATTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:504 DOGWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2526
Mailing Address - Country:US
Mailing Address - Phone:484-645-2015
Mailing Address - Fax:757-432-3216
Practice Address - Street 1:504 DOGWOOD CIR
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2526
Practice Address - Country:US
Practice Address - Phone:484-306-3126
Practice Address - Fax:757-432-3216
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015324363L00000X
PASP031865363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner