Individual provider Active NPI

Danielle Jacqueline Marese, P.A.

  • Physician Assistant
  • Plantation, FL
National Provider Identifier
1154694479
Registry record updated Aug 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9106459 Issued in FL
Practice address
1368 N University Dr
Plantation, FL 33322-4734
Phone
(954) 577-0001
Fax
(954) 577-0030
NPI assigned
Feb 16, 2012
Last updated
Aug 27, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9106459 FL Primary
Medical Physician Assistant 363AM0700X C0004683 MD

Addresses

Primary practice location

1368 N University Dr
Plantation, FL 33322-4734

Mailing address

1368 N University Dr
Plantation, FL 33322-4734
Phone (954) 577-0001

Other identifiers 2

IdentifierTypeStateIssuer
C0004683OtherMDPHYSICIAN ASSISTANT STATE LICENSE
PA9106459OtherFLPA -LICENSE -FLORIDA

Other names 1

  • Danielle Jacqueline Hernandez Former name

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
I20130517000186 FL Practitioner - Physician Assistant 4082851779 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9106459FLMDPhysician Assistant
C0004683MDMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Healthstone Medical Group, LLC CurrentSince Mar 23, 2013 Accepting new patients
MD Now Medical Centers Inc CurrentSince Aug 27, 2020 Accepting new patients
American Current Care PA CurrentSince May 15, 2017 Accepting new patients

Locations

4570 Lantana Rd
Lake Worth, FL 33463
Phone (305) 949-4141

2905 N Commerce Pkwy
Miramar, FL 33025
Phone (833) 582-1017

1770 NE Miami Gardens Dr
North Miami Beach, FL 33179
Phone (305) 949-4141

700 N Hiatus Rd
Ste 105
Pembroke Pines, FL 33026
Phone (954) 433-4744

Organizations & group practices 7

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

NPI Registry JSON

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

{
    "created_epoch": "1329350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598486400000",
    "number": "1154694479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1368 N UNIVERSITY DR",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333224734",
            "telephone_number": "954-577-0001",
            "fax_number": "954-577-0030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1368 N UNIVERSITY DR",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333224734",
            "telephone_number": "954-577-0001",
            "fax_number": "954-577-0030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARESE",
        "first_name": "DANIELLE",
        "middle_name": "JACQUELINE",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-16",
        "last_updated": "2020-08-27",
        "certification_date": "2020-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9106459",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C0004683",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT STATE LICENSE",
            "identifier": "C0004683",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA -LICENSE -FLORIDA",
            "identifier": "PA9106459",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DANIELLE",
            "last_name": "HERNANDEZ",
            "middle_name": "JACQUELINE",
            "credential": "P.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Plantation, FL

Sources for this page

Verify at the official NPI Registry.