Provider Demographics
NPI:1528547445
Name:REED, DANIELLE HAYDEN (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:HAYDEN
Last Name:REED
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:HAYDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 3123
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-3123
Mailing Address - Country:US
Mailing Address - Phone:904-217-7450
Mailing Address - Fax:904-217-7483
Practice Address - Street 1:14810 OLD SAINT AUGUSTINE RD STE 207
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2558
Practice Address - Country:US
Practice Address - Phone:904-217-7450
Practice Address - Fax:904-217-7483
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant