Provider Demographics
NPI:1053951442
Name:DONAHUE, PAUL ALBERT (APRN)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ALBERT
Last Name:DONAHUE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 DOGWOOD CT
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-7730
Mailing Address - Country:US
Mailing Address - Phone:856-723-4098
Mailing Address - Fax:
Practice Address - Street 1:432 DOGWOOD CT
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-7730
Practice Address - Country:US
Practice Address - Phone:856-723-4098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1104170363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily