Provider Demographics
NPI:1417135633
Name:DONOFRIO, MARI (ARNP)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:
Last Name:DONOFRIO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5908 CARIBBEAN PINE CIR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-3014
Mailing Address - Country:US
Mailing Address - Phone:954-740-1093
Mailing Address - Fax:954-714-1192
Practice Address - Street 1:5908 CARIBBEAN PINE CIR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-3014
Practice Address - Country:US
Practice Address - Phone:954-740-1093
Practice Address - Fax:954-714-1192
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9253622363LA2200X
FLARNP9253622363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004522100Medicaid