Provider Demographics
NPI:1447219597
Name:LYNESS, DONNA J (CRNA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:LYNESS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19548 SW 86TH LN
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432-2671
Mailing Address - Country:US
Mailing Address - Phone:304-777-9047
Mailing Address - Fax:
Practice Address - Street 1:3330 SW 33RD RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474
Practice Address - Country:US
Practice Address - Phone:352-873-9311
Practice Address - Fax:352-873-9652
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV33222367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5710452000Medicaid
P07686Medicare UPIN
WVLY6031243Medicare ID - Type Unspecified