Provider Demographics
NPI:1629802350
Name:DONALDSON JR., ROBERT ALLEN JR
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALLEN
Last Name:DONALDSON JR.
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 SW HOGAN ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-8765
Mailing Address - Country:US
Mailing Address - Phone:772-812-4142
Mailing Address - Fax:
Practice Address - Street 1:612 SW HOGAN ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-8765
Practice Address - Country:US
Practice Address - Phone:772-812-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLD543-761-90-148-0376J00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker