Provider Demographics
NPI:1114092889
Name:WYNN, DONNA H (ARNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:H
Last Name:WYNN
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 578
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-0578
Mailing Address - Country:US
Mailing Address - Phone:904-269-6340
Mailing Address - Fax:904-284-6373
Practice Address - Street 1:3229 BEAR RUN BLVD
Practice Address - Street 2:BLDG B
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-7334
Practice Address - Country:US
Practice Address - Phone:904-269-6340
Practice Address - Fax:904-284-6373
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP498812363LF0000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology