Provider Demographics
NPI:1649872060
Name:WORTHINGTON, DANIELLE RENAE (APRN)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:RENAE
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5398 W GRANTON LN
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-9367
Mailing Address - Country:US
Mailing Address - Phone:386-341-9517
Mailing Address - Fax:
Practice Address - Street 1:4701 SW COLLEGE RD STE 102
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4739
Practice Address - Country:US
Practice Address - Phone:352-835-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008954363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily