Provider Demographics
NPI:1780247429
Name:BOOTH, DANIELLE LEIGH (PA-C)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LEIGH
Last Name:BOOTH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7797 W PARADISE LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-5009
Mailing Address - Country:US
Mailing Address - Phone:623-547-7502
Mailing Address - Fax:
Practice Address - Street 1:1743 E CAMELBACK RD STE A3
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4015
Practice Address - Country:US
Practice Address - Phone:602-325-5114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8026363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant