Provider Demographics
NPI:1578701876
Name:DAVENPORT, DONNA B (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:B
Last Name:DAVENPORT
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 1:290 CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE D-2
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8130
Mailing Address - Country:US
Mailing Address - Phone:386-676-2302
Mailing Address - Fax:
Practice Address - Street 1:290 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE D-2
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8130
Practice Address - Country:US
Practice Address - Phone:386-676-2302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1341262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily