Provider Demographics
NPI:1003063538
Name:DISANTI, DONNA (APRN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:DISANTI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 EXECUTIVE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-5323
Mailing Address - Country:US
Mailing Address - Phone:727-347-0005
Mailing Address - Fax:727-541-6558
Practice Address - Street 1:508 N ALEXANDER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-3036
Practice Address - Country:US
Practice Address - Phone:813-759-6607
Practice Address - Fax:813-759-8997
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN2940562363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP2940562OtherSTATE LIC.