Provider Demographics
NPI:1083115513
Name:BAGLEY, DONNA LEE
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LEE
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DONNA
Other - Middle Name:LEE
Other - Last Name:RASMUSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12079 FINCH RD
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34614-3318
Mailing Address - Country:US
Mailing Address - Phone:352-428-4608
Mailing Address - Fax:
Practice Address - Street 1:2469 ENTERPRISE RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1702
Practice Address - Country:US
Practice Address - Phone:727-467-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator