Provider Demographics
NPI:1407887029
Name:O'DONNELL, ERICA LYNNE (DO)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNNE
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1400 HAND AVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8194
Mailing Address - Country:US
Mailing Address - Phone:386-671-2771
Mailing Address - Fax:386-671-6458
Practice Address - Street 1:1400 HAND AVE STE K
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8195
Practice Address - Country:US
Practice Address - Phone:386-671-2771
Practice Address - Fax:386-671-6458
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS7905207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00370444OtherMEDICARE RAILROAD
010034OtherFHCP
FL01768OtherMEDICARE
FL263358200Medicaid
FL01768OtherBLUE CROSS BLUE SHIELD
FL4046734003OtherCIGNA
FL7512263OtherAETNA