Provider Demographics
NPI:1760786008
Name:DONNELLY FAMILY PRACTITIONERS
Entity Type:Organization
Organization Name:DONNELLY FAMILY PRACTITIONERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:B
Authorized Official - Last Name:DONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:561-213-0763
Mailing Address - Street 1:42 SW 5TH WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-4731
Mailing Address - Country:US
Mailing Address - Phone:561-213-0763
Mailing Address - Fax:
Practice Address - Street 1:2900 N MILITARY TRL
Practice Address - Street 2:SUITE 245
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6365
Practice Address - Country:US
Practice Address - Phone:561-994-2007
Practice Address - Fax:561-994-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty