Individual provider Active NPI

Lita Marie Danlag, FNP-C

  • Nurse Practitioner
  • Crestview, FL
National Provider Identifier
1013877117
Registry record updated Jan 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN11043628 Issued in FL
Practice address
369 N Main St
Crestview, FL 32536-3541
Phone
(850) 398-6963
NPI assigned
Nov 12, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 26, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X APRN11043628 FL Primary

Addresses

Primary practice location

369 N Main St
Crestview, FL 32536-3541

Mailing address

2952 Chancellor CT
Crestview, FL 32539-4353
Phone (850) 496-4482

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260205002656 FL Practitioner - Nurse Practitioner 6709365273 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Main Street Medical Center of Crestview PAGroup PAC ID 2264518943, 7 clinicians

Practice addresses (Care Compare)

369 N Main St
Crestview, FL 32536-3541
Phone (850) 398-6963

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN11043628FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Main Street Medical Center of Crestview, PA Single Specialty CurrentSince Jan 20, 2026 Accepting new patients

Locations

369 N Main St
Crestview, FL 32536
Phone (850) 398-6963

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AJIDAA/Endpoint/AJIDAA

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1762905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769385600000",
    "number": "1013877117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2952 CHANCELLOR CT",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325394353",
            "telephone_number": "850-496-4482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "369 N MAIN ST",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325363541",
            "telephone_number": "850-398-6963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANLAG",
        "first_name": "LITA",
        "middle_name": "MARIE",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-11-12",
        "last_updated": "2026-01-26",
        "certification_date": "2026-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN11043628",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestview, FL

Sources for this page

Verify at the official NPI Registry.