Provider Demographics
NPI:1497443683
Name:DONALDSON, JB JR (BSN-RN)
Entity Type:Individual
Prefix:MR
First Name:JB
Middle Name:
Last Name:DONALDSON
Suffix:JR
Gender:M
Credentials:BSN-RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463688 STATE ROAD 200 STE 1
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-0304
Mailing Address - Country:US
Mailing Address - Phone:760-638-6632
Mailing Address - Fax:
Practice Address - Street 1:85030 MAJESTIC WALK BLVD
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034
Practice Address - Country:US
Practice Address - Phone:760-638-6632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9610040163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy