Provider Demographics
NPI:1033583877
Name:SUARES, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:SUARES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 SW SAINT LUCIE CRES APT 206
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2859
Mailing Address - Country:US
Mailing Address - Phone:772-224-8900
Mailing Address - Fax:
Practice Address - Street 1:524 SW SAINT LUCIE CRES APT 206
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2859
Practice Address - Country:US
Practice Address - Phone:772-224-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2017-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18755174400000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No174400000XOther Service ProvidersSpecialist