Provider Demographics
NPI:1831130061
Name:ANDRIES, DONNA M (ARNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:ANDRIES
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 1:785 PRIMERA BLVD
Mailing Address - Street 2:SUITE 1031
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2124
Mailing Address - Country:US
Mailing Address - Phone:407-834-8111
Mailing Address - Fax:407-708-1958
Practice Address - Street 1:785 PRIMERA BLVD
Practice Address - Street 2:SUITE 1031
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2124
Practice Address - Country:US
Practice Address - Phone:407-834-8111
Practice Address - Fax:407-708-1958
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9198426363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307187100Medicaid
Q52134Medicare UPIN
FL307187100Medicaid