Provider Demographics
NPI:1275523326
Name:IRWIN, DONNA LEE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LEE
Last Name:IRWIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32035-0517
Mailing Address - Country:US
Mailing Address - Phone:904-548-1800
Mailing Address - Fax:904-277-7286
Practice Address - Street 1:45377 MICKLER ST
Practice Address - Street 2:
Practice Address - City:CALLAHAN
Practice Address - State:FL
Practice Address - Zip Code:32011-3001
Practice Address - Country:US
Practice Address - Phone:904-879-2306
Practice Address - Fax:904-879-6377
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP388122363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL034055300Medicaid
FL034055300Medicaid
FLE30672Medicare PIN