Provider Demographics
NPI:1386275303
Name:GROAT, DANIELLE MARIE (MSN, APRN, AGACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:MARIE
Last Name:GROAT
Suffix:
Gender:
Credentials:MSN, APRN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 GEYSER RD
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-3007
Mailing Address - Country:US
Mailing Address - Phone:518-289-2720
Mailing Address - Fax:518-886-5880
Practice Address - Street 1:510 GEYSER RD
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-3007
Practice Address - Country:US
Practice Address - Phone:518-289-2720
Practice Address - Fax:518-288-3326
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY432417363LA2100X
FLAPRN11005956363LA2100X
TN28/203363LA2100X
NY695614163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105577700Medicaid