Provider Demographics
NPI:1750936076
Name:VITTATOE, DANIELLE STEPHANIE (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:STEPHANIE
Last Name:VITTATOE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:DANIELLE
Other - Middle Name:STEPHANIE
Other - Last Name:VITTATOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1624 OLD NILES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-5632
Mailing Address - Country:US
Mailing Address - Phone:865-310-8877
Mailing Address - Fax:
Practice Address - Street 1:907 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5016
Practice Address - Country:US
Practice Address - Phone:865-977-5565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-04
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26409363L00000X
TN0000205318163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse