Healthcare Provider Details

I. General information

NPI: 1649872060
Provider Name (Legal Business Name): DANIELLE RENAE WORTHINGTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 N HERITAGE OAKS PATH
HERNANDO FL
34442-6332
US

IV. Provider business mailing address

5398 W GRANTON LN
LECANTO FL
34461-9367
US

V. Phone/Fax

Practice location:
  • Phone: 352-270-8493
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11008954
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: