Provider Demographics
NPI:1073779674
Name:BAXTER, DONNA ELAINE (LMT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:ELAINE
Last Name:BAXTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6316 DRAW LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-5199
Mailing Address - Country:US
Mailing Address - Phone:941-724-0901
Mailing Address - Fax:
Practice Address - Street 1:5580 BEE RIDGE RD
Practice Address - Street 2:BLDG B
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1505
Practice Address - Country:US
Practice Address - Phone:941-724-0901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-03
Last Update Date:2008-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA36577171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor