Provider Demographics
NPI:1346725025
Name:IVERSON, DONNA RAY (ARNP - BC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:RAY
Last Name:IVERSON
Suffix:
Gender:F
Credentials:ARNP - BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 748519
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8519
Mailing Address - Country:US
Mailing Address - Phone:904-376-3800
Mailing Address - Fax:904-376-3998
Practice Address - Street 1:302 3RD ST STE 3
Practice Address - Street 2:
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-5139
Practice Address - Country:US
Practice Address - Phone:904-376-3800
Practice Address - Fax:904-390-7427
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9361093363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health