Provider Demographics
NPI:1093007130
Name:LANTON, DONNA-MARIE PHYLLIS (APRN)
Entity Type:Individual
Prefix:MRS
First Name:DONNA-MARIE
Middle Name:PHYLLIS
Last Name:LANTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DONNA-MARIE
Other - Middle Name:PHYLLIS
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:985 SR 436
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5994
Mailing Address - Country:US
Mailing Address - Phone:407-831-5252
Mailing Address - Fax:407-831-3390
Practice Address - Street 1:985 SR 436
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5994
Practice Address - Country:US
Practice Address - Phone:407-831-5252
Practice Address - Fax:407-831-3390
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9181760363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005451700Medicaid
FL005451700Medicaid
FLFC132WMedicare PIN
FL005451700Medicaid
FLK4341Medicare PIN
FLFC132ZMedicare PIN
FLFC132VMedicare PIN