Provider Demographics
NPI:1164451647
Name:GORDON, DONNA ANITA (AUDIOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:ANITA
Last Name:GORDON
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:ANITA
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 95004
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33804-5004
Mailing Address - Country:US
Mailing Address - Phone:863-680-7206
Mailing Address - Fax:863-680-7420
Practice Address - Street 1:1755 N. FLORIDA AVENUE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3109
Practice Address - Country:US
Practice Address - Phone:863-904-6200
Practice Address - Fax:863-904-6280
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1034231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL600551900Medicaid
FL600551900Medicaid