Provider Demographics
NPI:1053656454
Name:WITKOWSKI, DANIELLE (CRNA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:WITKOWSKI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:BRINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:7600 W SUNRISE BLVD
Mailing Address - Street 2:MAILSTOP PL-31
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-4113
Mailing Address - Country:US
Mailing Address - Phone:954-939-2371
Mailing Address - Fax:954-851-1746
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-1149
Practice Address - Country:US
Practice Address - Phone:352-273-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9250190363LW0102X
FLRN9250190367500000X
VA0024188492367500000X
FLARNP9250190367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008386600Medicaid