Healthcare Provider Details

I. General information

NPI: 1275387227
Provider Name (Legal Business Name): HANNA DANIELE VEACH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. HANNA DANIELE CLARK

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-0326
US

IV. Provider business mailing address

PO BOX 100286
GAINESVILLE FL
32610-0286
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0535
  • Fax: 352-627-4173
Mailing address:
  • Phone: 352-265-0535
  • Fax: 352-627-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9119009
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: