Provider Demographics
NPI:1649255662
Name:DONALDSON, YVETTE DENISE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:YVETTE
Middle Name:DENISE
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:YVETTE
Other - Middle Name:MCLAUGHLIN
Other - Last Name:DONALDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:4821 US HIGHWAY 98 W STE 104
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-8575
Mailing Address - Country:US
Mailing Address - Phone:850-622-2055
Mailing Address - Fax:850-622-2053
Practice Address - Street 1:4821 US HIGHWAY 98 W STE 104
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-8575
Practice Address - Country:US
Practice Address - Phone:850-622-2055
Practice Address - Fax:850-622-2053
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3328422363L00000X
AL1095903363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051555443Medicaid
FL306135300Medicaid
AL051555443Medicaid
AL051555443DONMedicare ID - Type Unspecified