Provider Demographics
NPI:1598749350
Name:SHOUDY, DONNA J (MSN, ARNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:SHOUDY
Suffix:
Gender:F
Credentials:MSN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100197
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0197
Mailing Address - Country:US
Mailing Address - Phone:352-548-1101
Mailing Address - Fax:352-273-6536
Practice Address - Street 1:101 S. NEWELL DRIVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611
Practice Address - Country:US
Practice Address - Phone:352-548-1101
Practice Address - Fax:352-273-6536
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1083012363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303057100Medicaid
FLS30737Medicare UPIN
FL303057100Medicaid