Provider Demographics
NPI:1114952702
Name:ROBERTS, DONNA L (ANP-BC)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2254 POINCIANA DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-2749
Mailing Address - Country:US
Mailing Address - Phone:239-770-2655
Mailing Address - Fax:
Practice Address - Street 1:9655 TAMIAMI TRL N
Practice Address - Street 2:SUITE 102
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-2796
Practice Address - Country:US
Practice Address - Phone:239-594-8746
Practice Address - Fax:239-594-1595
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA200182363LA2200X
FLARNP9271257363LA2200X
NY437135-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP537601Medicare PIN