Provider Demographics
NPI:1700610078
Name:ROTA, DANIELLE (AGACNP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:ROTA
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 DAVID DR
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-1506
Mailing Address - Country:US
Mailing Address - Phone:609-381-4176
Mailing Address - Fax:
Practice Address - Street 1:123 EGG HARBOR RD STE 403
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9407
Practice Address - Country:US
Practice Address - Phone:856-227-4606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15112800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner