Provider Demographics
NPI:1346274701
Name:DONOVAN, DONALD WILLIAM JR (PA-C)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:WILLIAM
Last Name:DONOVAN
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2848 WEBBER PL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-4854
Mailing Address - Country:US
Mailing Address - Phone:941-378-3933
Mailing Address - Fax:941-921-0043
Practice Address - Street 1:4450 S TAMIAMI TRL
Practice Address - Street 2:SUITE A
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3454
Practice Address - Country:US
Practice Address - Phone:941-927-1234
Practice Address - Fax:941-921-0043
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA1805363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL324166OtherHEALTH AMERICA
FL6986161OtherCIGNA
FL7834OtherHEALTHPARTNERS
FL324166OtherADVANTRA
FL00233OtherUNIVERSAL
FL721578OtherUPMC
FL324166OtherCOVENTRY
FL4610481OtherAETNA
FL142454OtherCARE CHOICES
FL142454OtherPREFFERED CHOICES
FL970023784OtherRAIL ROAD MEDICARE
FL12596OtherBCBS
FL15474OtherSTAYWELL HEALTHEASE WELLC
FL650123956012OtherMEDICAL MUTUAL
FL142454OtherCARE CHOICES
FL7834OtherHEALTHPARTNERS
FL324166OtherCOVENTRY