Provider Demographics
NPI:1023661741
Name:EAST, DOREEN MAY (ARNP)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:MAY
Last Name:EAST
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 BAY VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3145
Mailing Address - Country:US
Mailing Address - Phone:954-822-5134
Mailing Address - Fax:561-793-6418
Practice Address - Street 1:1217 BAY VIEW WAY
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3145
Practice Address - Country:US
Practice Address - Phone:954-822-5134
Practice Address - Fax:561-793-6418
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3354992163W00000X
FL11007897363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse