Provider Demographics
NPI:1013284173
Name:MACDONALD, CELESTE ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:ANN
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:ANN
Other - Last Name:MACDONALD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1211 TMH CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4621
Mailing Address - Country:US
Mailing Address - Phone:850-431-6183
Mailing Address - Fax:850-431-6497
Practice Address - Street 1:930 MAR WALT DRIVE
Practice Address - Street 2:UNIT C
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6706
Practice Address - Country:US
Practice Address - Phone:850-431-6183
Practice Address - Fax:850-431-6497
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3132922363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner