Provider Demographics
NPI:1548773096
Name:SMITH, DONNA J (AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:J
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGNP-C
Mailing Address - Street 1:6581 SE BALTUSROL TERR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997
Mailing Address - Country:US
Mailing Address - Phone:631-487-8960
Mailing Address - Fax:
Practice Address - Street 1:6581 SE BALTUSROL TER
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-8679
Practice Address - Country:US
Practice Address - Phone:631-487-8960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9347776363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner