Provider Demographics
NPI:1386630846
Name:SMITH, DONNA DORMAN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:DORMAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:DORMAN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4800 BELFORT ROAD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-483-5850
Mailing Address - Fax:904-483-5860
Practice Address - Street 1:4800 BELFORT ROAD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-265-4801
Practice Address - Fax:904-265-4811
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9244967367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307782900Medicaid
FL307782900Medicaid