Provider Demographics
NPI:1609835693
Name:WORMAN, DONNA LANTZ (RN, LHRM)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LANTZ
Last Name:WORMAN
Suffix:
Gender:F
Credentials:RN, LHRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 PINEHURST AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEAIR BLUFFS
Mailing Address - State:FL
Mailing Address - Zip Code:33770-1767
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3044 PINEHURST AVE
Practice Address - Street 2:
Practice Address - City:BELLEAIR BLUFFS
Practice Address - State:FL
Practice Address - Zip Code:33770-1767
Practice Address - Country:US
Practice Address - Phone:727-584-5724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1631122163WA2000X
FL5500790173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No173000000XOther Service ProvidersLegal Medicine