Provider Demographics
NPI:1154694479
Name:MARESE, DANIELLE JACQUELINE (PA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:JACQUELINE
Last Name:MARESE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:JACQUELINE
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1368 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-4734
Mailing Address - Country:US
Mailing Address - Phone:954-577-0001
Mailing Address - Fax:954-577-0030
Practice Address - Street 1:1368 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-4734
Practice Address - Country:US
Practice Address - Phone:954-577-0001
Practice Address - Fax:954-577-0030
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106459363A00000X
MDC0004683363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9106459OtherPA -LICENSE -FLORIDA
MDC0004683OtherPHYSICIAN ASSISTANT STATE LICENSE