Provider Demographics
NPI:1205887726
Name:DONOVAN, JUDITH JAYE
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:JAYE
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JUDITH
Other - Middle Name:JAYE
Other - Last Name:DONOVAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:8657 CHAMPIONS PT
Mailing Address - Street 2:UNIT 1402
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-3079
Mailing Address - Country:US
Mailing Address - Phone:239-877-6924
Mailing Address - Fax:
Practice Address - Street 1:730 GOODLETTE RD N
Practice Address - Street 2:SUITE 200
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5616
Practice Address - Country:US
Practice Address - Phone:239-659-6400
Practice Address - Fax:239-659-7030
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3398732367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG3760Medicare ID - Type UnspecifiedPROVIDER NUMBER