Provider Demographics
NPI:1669565693
Name:DEAN, DANIELLE (PHYSICIAN ASST)
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:PHYSICIAN ASST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2401 FRIST BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4800
Mailing Address - Country:US
Mailing Address - Phone:772-466-1567
Mailing Address - Fax:772-466-1595
Practice Address - Street 1:2401 FRIST BLVD STE 4
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4800
Practice Address - Country:US
Practice Address - Phone:772-466-1567
Practice Address - Fax:772-466-1595
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103910363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical