Provider Demographics
NPI:1407978737
Name:PIERCE, DONNA MICHELLE (FNP C)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MICHELLE
Last Name:PIERCE
Suffix:
Gender:F
Credentials:FNP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-3639
Mailing Address - Country:US
Mailing Address - Phone:229-386-1528
Mailing Address - Fax:229-388-0556
Practice Address - Street 1:1806 LEE AVE
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3639
Practice Address - Country:US
Practice Address - Phone:229-386-1528
Practice Address - Fax:229-388-0556
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN089608NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000836129FMedicaid
GA000836129FMedicaid
GA202I508553Medicare PIN