Provider Demographics
NPI:1033184791
Name:DONOFRIO, ROBERT NICHOLAS (ARNP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:NICHOLAS
Last Name:DONOFRIO
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 HOSPITAL DR NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5063
Mailing Address - Country:US
Mailing Address - Phone:850-833-7451
Mailing Address - Fax:850-833-7439
Practice Address - Street 1:137 HOSPITAL DR NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5063
Practice Address - Country:US
Practice Address - Phone:850-833-7451
Practice Address - Fax:850-833-7439
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 679762363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2058725OtherCIGNA
FLY3205OtherBCBS
FL1000877OtherUNITED HEALTHCARE
FL761969300Medicaid
FL761969300Medicaid