Provider Demographics
NPI:1740459676
Name:POWELL, DONNA ROMONA (DO)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:ROMONA
Last Name:POWELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 W CYPRESS ST STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-3804
Mailing Address - Country:US
Mailing Address - Phone:813-542-2589
Mailing Address - Fax:813-932-1980
Practice Address - Street 1:5016 W CYPRESS ST STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-3804
Practice Address - Country:US
Practice Address - Phone:813-542-2589
Practice Address - Fax:813-392-1980
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10267207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0077381-00Medicaid
FLGT559ZMedicare PIN