Provider Demographics
NPI:1841417623
Name:WEIDEMA, DONNA WEIDEMA (ARNP)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:WEIDEMA
Last Name:WEIDEMA
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 1:630 LAYNE BLVD
Mailing Address - Street 2:#202
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-6584
Mailing Address - Country:US
Mailing Address - Phone:305-490-7581
Mailing Address - Fax:
Practice Address - Street 1:3000 NE 151ST ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-3605
Practice Address - Country:US
Practice Address - Phone:305-919-5620
Practice Address - Fax:305-919-4003
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL625742390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program