Provider Demographics
NPI:1134320807
Name:MESSINA, DONNA M (LMT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:MESSINA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8349 COUNTRY WALK DR APT A
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-4691
Mailing Address - Country:US
Mailing Address - Phone:850-324-3792
Mailing Address - Fax:
Practice Address - Street 1:8349 COUNTRY WALK DR APT A
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-4691
Practice Address - Country:US
Practice Address - Phone:850-324-3792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA40965174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA40965OtherLICENSE NUMBER