Provider Demographics
NPI:1619015955
Name:MAZZIOTTA, DANIELLE (ARNP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MAZZIOTTA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 SAINT JAMES CT STE 1
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5352
Mailing Address - Country:US
Mailing Address - Phone:850-431-7021
Mailing Address - Fax:
Practice Address - Street 1:3900 ESPLANADE WAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-0802
Practice Address - Country:US
Practice Address - Phone:850-431-3867
Practice Address - Fax:850-431-3879
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2521822363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner