Provider Demographics
NPI:1750890471
Name:O'HARE, DANNIELLE LORAIN (ARNP)
Entity type:Individual
Prefix:MS
First Name:DANNIELLE
Middle Name:LORAIN
Last Name:O'HARE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DANNIELLE
Other - Middle Name:
Other - Last Name:DEATHERAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2795 W NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-3705
Mailing Address - Country:US
Mailing Address - Phone:321-622-8626
Mailing Address - Fax:321-622-8627
Practice Address - Street 1:2795 W NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-3705
Practice Address - Country:US
Practice Address - Phone:321-622-8626
Practice Address - Fax:321-622-8627
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9188400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily