Provider Demographics
NPI:1114972841
Name:MCDONALD, ROXANNA A (ARNP)
Entity Type:Individual
Prefix:
First Name:ROXANNA
Middle Name:A
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ROXANNA
Other - Middle Name:A
Other - Last Name:MCDONALD-EBANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1947 MORNINGSIDE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-9390
Mailing Address - Country:US
Mailing Address - Phone:904-402-9111
Mailing Address - Fax:
Practice Address - Street 1:1947 MORNINGSIDE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-9390
Practice Address - Country:US
Practice Address - Phone:904-402-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2808122363LA2100X, 363LP2300X
FLARNP2808122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305270200Medicaid
FL188514OtherHEALTHEASE
FL500030444OtherMCR RR
FL2061018OtherFCA
FLY7859OtherBCBS FLORIDA
FL2061018OtherFCA
FL305270200Medicaid