Provider Demographics
NPI:1154057198
Name:DOOLAN, JONATHAN (APRN)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:DOOLAN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7003 JOLEE RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-4436
Mailing Address - Country:US
Mailing Address - Phone:850-890-1291
Mailing Address - Fax:
Practice Address - Street 1:2306 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4404
Practice Address - Country:US
Practice Address - Phone:850-250-0021
Practice Address - Fax:850-250-0022
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-30
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11019055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily