Provider Demographics
NPI:1255703302
Name:COTHREN, DONNA JEANNETTE
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:JEANNETTE
Last Name:COTHREN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DONNA
Other - Middle Name:JEANNETTE
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:6387 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BRYCEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32009-1838
Mailing Address - Country:US
Mailing Address - Phone:904-424-7804
Mailing Address - Fax:
Practice Address - Street 1:4319 SALISBURY RD STE 103
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0941
Practice Address - Country:US
Practice Address - Phone:904-570-9404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9167134363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily