Provider Demographics
NPI:1104825496
Name:DOROSHEFF, DEENA C (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:DEENA
Middle Name:C
Last Name:DOROSHEFF
Suffix:
Gender:F
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:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:GLEN ST MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32040-0606
Mailing Address - Country:US
Mailing Address - Phone:904-653-1818
Mailing Address - Fax:904-653-1814
Practice Address - Street 1:14861 NW US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-8203
Practice Address - Country:US
Practice Address - Phone:386-462-1911
Practice Address - Fax:386-462-1943
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9170108363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303211600Medicaid