Provider Demographics
NPI:1740881416
Name:JAMIESON, DONALD DOUGLASS
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:DOUGLASS
Last Name:JAMIESON
Suffix:
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 1:12424 SAULSTON PL
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34669-5009
Mailing Address - Country:US
Mailing Address - Phone:727-808-3352
Mailing Address - Fax:
Practice Address - Street 1:17929 HUNTING BOW CIR # NA
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-5378
Practice Address - Country:US
Practice Address - Phone:813-792-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF07200826363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily