Provider Demographics
NPI:1558337170
Name:HENDERSON, DONNA (AP, RN)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:AP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S LAWRENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:KEYSTONE HEIGHTS
Mailing Address - State:FL
Mailing Address - Zip Code:32656-9219
Mailing Address - Country:US
Mailing Address - Phone:352-222-1679
Mailing Address - Fax:
Practice Address - Street 1:310 S LAWRENCE BLVD
Practice Address - Street 2:
Practice Address - City:KEYSTONE HEIGHTS
Practice Address - State:FL
Practice Address - Zip Code:32656-9219
Practice Address - Country:US
Practice Address - Phone:352-222-1679
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1542171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0697OtherBLUE CROSS BLUE SHIELD