Provider Demographics
NPI:1497757926
Name:DILLON, DONNA ELLZEY (ARNP, BC, MS)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:ELLZEY
Last Name:DILLON
Suffix:
Gender:F
Credentials:ARNP, BC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 8TH AVE W
Mailing Address - Street 2:STE 101
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4737
Mailing Address - Country:US
Mailing Address - Phone:941-776-4008
Mailing Address - Fax:941-845-4963
Practice Address - Street 1:5325 26TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-3012
Practice Address - Country:US
Practice Address - Phone:941-752-7173
Practice Address - Fax:941-567-6277
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1727122363LP0808X
FLARNP1727122364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308496500Medicaid
FL768487800Medicaid
Q34991Medicare UPIN
FL768487800Medicaid